- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $14,885.00 / $23,236.80
| Facility | | $4,804.00 | $14,885.00 | $23,236.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,408.60 / $14,564.26 / $21,431.74
| Facility | | $7,408.60 | $14,564.26 | $21,431.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.00 / $3,027.00 / $14,968.62
| Facility | | $688.00 | $3,027.00 | $14,968.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,800.65 / $14,453.00 / $24,782.45
| Facility | | $8,800.65 | $14,453.00 | $24,782.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,634.59 / $32,138.74 / $32,138.74
| Facility | | $19,634.59 | $32,138.74 | $32,138.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,050.75 / $12,812.50 / $24,782.45
| Facility | | $9,050.75 | $12,812.50 | $24,782.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,228.13 / $11,480.00 / $26,246.15
| Facility | | $4,228.13 | $11,480.00 | $26,246.15 |