- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,627.37 / $17,890.09 / $23,358.00
| Facility | | $8,627.37 | $17,890.09 | $23,358.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $708.00 / $5,840.42 / $34,723.15
| Facility | | $708.00 | $5,840.42 | $34,723.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,108.49 / $16,714.61 / $25,255.98
| Facility | | $10,108.49 | $16,714.61 | $25,255.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,736.47 / $23,736.47 / $23,736.47
| Facility | | $23,736.47 | $23,736.47 | $23,736.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,564.36 / $16,838.46 / $26,002.54
| Facility | | $14,564.36 | $16,838.46 | $26,002.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $708.00 / $5,840.42 / $34,723.15
| Facility | | $708.00 | $5,840.42 | $34,723.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $708.00 / $2,989.00 / $19,221.50
| Facility | | $708.00 | $2,989.00 | $19,221.50 |