- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $11,568.00 / $18,104.30
| Facility | | $4,804.00 | $11,568.00 | $18,104.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,926.83 / $16,940.82 / $22,749.94
| Facility | | $11,926.83 | $16,940.82 | $22,749.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.00 / $2,765.00 / $11,580.54
| Facility | | $688.00 | $2,765.00 | $11,580.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,856.78 / $11,215.00 / $19,308.55
| Facility | | $6,856.78 | $11,215.00 | $19,308.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,260.80 / $24,979.52 / $24,979.52
| Facility | | $15,260.80 | $24,979.52 | $24,979.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,451.45 / $31,451.45 / $31,451.45
| Facility | | $31,451.45 | $31,451.45 | $31,451.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,024.00 / $9,982.50 / $19,308.55
| Facility | | $7,024.00 | $9,982.50 | $19,308.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,833.28 / $8,944.32 / $20,210.97
| Facility | | $3,833.28 | $8,944.32 | $20,210.97 |