- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $12,448.00 / $20,548.09
| Facility | | $4,804.00 | $12,448.00 | $20,548.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,741.02 / $11,741.02 / $19,665.58
| Facility | | $11,741.02 | $11,741.02 | $19,665.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.00 / $2,753.00 / $12,460.04
| Facility | | $688.00 | $2,753.00 | $12,460.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,782.35 / $12,236.40 / $21,914.94
| Facility | | $7,782.35 | $12,236.40 | $21,914.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,419.80 / $26,876.62 / $26,876.62
| Facility | | $16,419.80 | $26,876.62 | $26,876.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,973.00 / $11,203.10 / $21,914.94
| Facility | | $7,973.00 | $11,203.10 | $21,914.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,800.00 / $10,151.68 / $23,115.01
| Facility | | $3,800.00 | $10,151.68 | $23,115.01 |