- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $15,990.00 / $24,279.60
| Facility | | $4,804.00 | $15,990.00 | $24,279.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,457.91 / $14,457.91 / $14,524.74
| Facility | | $14,457.91 | $14,457.91 | $14,524.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $687.00 / $2,767.00 / $16,753.24
| Facility | | $687.00 | $2,767.00 | $16,753.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,365.90 / $16,065.00 / $29,968.72
| Facility | | $9,365.90 | $16,065.00 | $29,968.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,095.70 / $34,530.33 / $34,530.33
| Facility | | $21,095.70 | $34,530.33 | $34,530.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,073.14 / $24,073.14 / $24,073.14
| Facility | | $24,073.14 | $24,073.14 | $24,073.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,456.93 / $13,569.57 / $32,195.33
| Facility | | $9,456.93 | $13,569.57 | $32,195.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,417.88 / $11,995.20 / $27,424.03
| Facility | | $4,417.88 | $11,995.20 | $27,424.03 |