- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $15,539.00 / $25,646.60
| Facility | | $4,804.00 | $15,539.00 | $25,646.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,761.84 / $15,761.84 / $15,761.84
| Facility | | $15,761.84 | $15,761.84 | $15,761.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $687.00 / $2,767.00 / $16,234.48
| Facility | | $687.00 | $2,767.00 | $16,234.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,893.21 / $16,937.82 / $30,780.41
| Facility | | $9,893.21 | $16,937.82 | $30,780.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,499.09 / $33,553.79 / $33,553.79
| Facility | | $20,499.09 | $33,553.79 | $33,553.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,989.37 / $14,333.57 / $33,666.36
| Facility | | $9,989.37 | $14,333.57 | $33,666.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,412.07 / $12,445.43 / $28,850.41
| Facility | | $4,412.07 | $12,445.43 | $28,850.41 |