- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $13,553.10 / $20,464.20
| Facility | | $4,804.00 | $13,553.10 | $20,464.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,207.99 / $19,106.07 / $19,951.45
| Facility | | $14,207.99 | $19,106.07 | $19,951.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.00 / $2,990.00 / $13,938.23
| Facility | | $688.00 | $2,990.00 | $13,938.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,750.58 / $12,728.00 / $23,795.17
| Facility | | $7,750.58 | $12,728.00 | $23,795.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,057.00 / $31,193.30 / $31,193.30
| Facility | | $19,057.00 | $31,193.30 | $31,193.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,940.00 / $11,283.75 / $26,025.74
| Facility | | $7,940.00 | $11,283.75 | $26,025.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,648.00 / $11,495.88 / $24,752.03
| Facility | | $4,648.00 | $11,495.88 | $24,752.03 |