- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $11,760.00 / $18,829.70
| Facility | | $4,804.00 | $11,760.00 | $18,829.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,287.51 / $13,287.51 / $13,287.51
| Facility | | $13,287.51 | $13,287.51 | $13,287.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.00 / $2,813.99 / $11,811.87
| Facility | | $688.00 | $2,813.99 | $11,811.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,131.53 / $11,213.10 / $20,082.25
| Facility | | $7,131.53 | $11,213.10 | $20,082.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,513.50 / $25,393.15 / $25,393.15
| Facility | | $15,513.50 | $25,393.15 | $25,393.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,580.58 / $27,580.58 / $27,580.58
| Facility | | $27,580.58 | $27,580.58 | $27,580.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,306.00 / $10,266.21 / $20,082.25
| Facility | | $7,306.00 | $10,266.21 | $20,082.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,341.55 / $10,577.69 / $22,775.05
| Facility | | $4,341.55 | $10,577.69 | $22,775.05 |