- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,053.00 / $11,860.40 / $18,127.30
| Facility | | $5,053.00 | $11,860.40 | $18,127.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,114.77 / $14,114.77 / $14,114.77
| Facility | | $14,114.77 | $14,114.77 | $14,114.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,057.97 / $12,508.90 / $18,636.48
| Facility | | $8,057.97 | $12,508.90 | $18,636.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,637.92 / $11,871.20 / $21,584.00
| Facility | | $8,637.92 | $11,871.20 | $21,584.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.82 / $133.38 / $247.10
| Facility | | $91.82 | $133.38 | $247.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,971.00 / $9,197.00 / $18,822.33
| Facility | | $3,971.00 | $9,197.00 | $18,822.33 |