- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $11,220.00 / $17,417.40
| Facility | | $4,804.00 | $11,220.00 | $17,417.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,795.70 / $12,623.53 / $19,302.93
| Facility | | $10,795.70 | $12,623.53 | $19,302.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.00 / $2,753.00 / $11,226.17
| Facility | | $688.00 | $2,753.00 | $11,226.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,596.62 / $10,833.00 / $19,570.00
| Facility | | $6,596.62 | $10,833.00 | $19,570.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,795.30 / $24,217.57 / $24,217.57
| Facility | | $14,795.30 | $24,217.57 | $24,217.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,758.00 / $9,603.75 / $19,570.00
| Facility | | $6,758.00 | $9,603.75 | $19,570.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,687.84 / $8,604.95 / $19,673.09
| Facility | | $3,687.84 | $8,604.95 | $19,673.09 |