- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $11,482.00 / $18,754.90
| Facility | | $4,804.00 | $11,482.00 | $18,754.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,160.32 / $12,160.32 / $16,225.18
| Facility | | $12,160.32 | $12,160.32 | $16,225.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.00 / $2,848.54 / $11,830.90
| Facility | | $688.00 | $2,848.54 | $11,830.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,103.20 / $11,665.00 / $20,002.46
| Facility | | $7,103.20 | $11,665.00 | $20,002.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,148.70 / $24,796.03 / $24,796.03
| Facility | | $15,148.70 | $24,796.03 | $24,796.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,488.25 / $13,505.25 / $54,605.61
| Facility | | $9,488.25 | $13,505.25 | $54,605.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,277.00 / $10,341.25 / $20,002.46
| Facility | | $7,277.00 | $10,341.25 | $20,002.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,775.00 / $9,265.76 / $21,183.84
| Facility | | $3,775.00 | $9,265.76 | $21,183.84 |