- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $13,916.00 / $21,883.40
| Facility | | $4,804.00 | $13,916.00 | $21,883.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,627.48 / $15,221.70 / $18,918.47
| Facility | | $10,627.48 | $15,221.70 | $18,918.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.00 / $2,990.00 / $13,930.67
| Facility | | $688.00 | $2,990.00 | $13,930.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,288.07 / $13,611.00 / $25,445.31
| Facility | | $8,288.07 | $13,611.00 | $25,445.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,357.80 / $30,048.82 / $30,048.82
| Facility | | $18,357.80 | $30,048.82 | $30,048.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,523.60 / $12,066.25 / $27,830.56
| Facility | | $8,523.60 | $12,066.25 | $27,830.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.86 / $10,811.36 / $24,717.47
| Facility | | $3,981.86 | $10,811.36 | $24,717.47 |