- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $10,792.00 / $18,149.59
| Facility | | $4,804.00 | $10,792.00 | $18,149.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,924.77 / $10,924.77 / $10,924.77
| Facility | | $10,924.77 | $10,924.77 | $10,924.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.00 / $2,759.00 / $11,226.17
| Facility | | $688.00 | $2,759.00 | $11,226.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,873.95 / $11,288.00 / $21,103.82
| Facility | | $6,873.95 | $11,288.00 | $21,103.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,236.70 / $23,303.23 / $23,303.23
| Facility | | $14,236.70 | $23,303.23 | $23,303.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,069.30 / $10,007.50 / $23,082.10
| Facility | | $7,069.30 | $10,007.50 | $23,082.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,428.97 / $8,966.71 / $20,416.90
| Facility | | $3,428.97 | $8,966.71 | $20,416.90 |