- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $16,752.00 / $26,372.00
| Facility | | $4,804.00 | $16,752.00 | $26,372.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,791.18 / $16,791.18 / $16,791.18
| Facility | | $16,791.18 | $16,791.18 | $16,791.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.00 / $3,027.00 / $17,476.84
| Facility | | $688.00 | $3,027.00 | $17,476.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,988.09 / $15,704.55 / $28,126.27
| Facility | | $9,988.09 | $15,704.55 | $28,126.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,100.80 / $36,175.51 / $36,175.51
| Facility | | $22,100.80 | $36,175.51 | $36,175.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.00 / $14,378.39 / $28,126.27
| Facility | | $10,232.00 | $14,378.39 | $28,126.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,982.41 / $12,797.46 / $29,440.80
| Facility | | $4,982.41 | $12,797.46 | $29,440.80 |