- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $12,872.00 / $20,301.00
| Facility | | $4,804.00 | $12,872.00 | $20,301.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,087.80 / $14,087.80 / $25,710.79
| Facility | | $14,087.80 | $14,087.80 | $25,710.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $675.00 / $2,632.00 / $12,046.47
| Facility | | $675.00 | $2,632.00 | $12,046.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,611.75 / $12,089.25 / $21,651.40
| Facility | | $7,611.75 | $12,089.25 | $21,651.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,982.20 / $27,797.18 / $27,797.18
| Facility | | $16,982.20 | $27,797.18 | $27,797.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47,690.84 / $47,690.84 / $47,690.84
| Facility | | $47,690.84 | $47,690.84 | $47,690.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,854.00 / $11,068.38 / $21,651.40
| Facility | | $7,854.00 | $11,068.38 | $21,651.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,800.00 / $10,029.60 / $22,930.17
| Facility | | $3,800.00 | $10,029.60 | $22,930.17 |