- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $11,527.70 / $17,406.00
| Facility | | $4,804.00 | $11,527.70 | $17,406.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,263.14 / $12,263.14 / $18,054.33
| Facility | | $12,263.14 | $12,263.14 | $18,054.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.00 / $2,767.00 / $12,133.96
| Facility | | $688.00 | $2,767.00 | $12,133.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,592.33 / $10,826.00 / $18,563.87
| Facility | | $6,592.33 | $10,826.00 | $18,563.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,688.30 / $25,679.27 / $25,679.27
| Facility | | $15,688.30 | $25,679.27 | $25,679.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,754.00 / $9,597.50 / $18,563.87
| Facility | | $6,754.00 | $9,597.50 | $18,563.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,685.44 / $8,599.36 / $19,660.29
| Facility | | $3,685.44 | $8,599.36 | $19,660.29 |