- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $13,197.00 / $20,074.30
| Facility | | $4,804.00 | $13,197.00 | $20,074.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $675.00 / $2,643.00 / $12,381.94
| Facility | | $675.00 | $2,643.00 | $12,381.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,602.90 / $11,954.25 / $21,409.62
| Facility | | $7,602.90 | $11,954.25 | $21,409.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,411.59 / $28,500.04 / $28,500.04
| Facility | | $17,411.59 | $28,500.04 | $28,500.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,549.13 / $15,549.13 / $15,549.13
| Facility | | $15,549.13 | $15,549.13 | $15,549.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,789.00 / $11,068.75 / $25,529.85
| Facility | | $7,789.00 | $11,068.75 | $25,529.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,792.60 / $9,917.60 / $22,582.02
| Facility | | $3,792.60 | $9,917.60 | $22,582.02 |