- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $12,732.00 / $20,736.20
| Facility | | $4,804.00 | $12,732.00 | $20,736.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,131.31 / $13,758.78 / $20,392.98
| Facility | | $6,131.31 | $13,758.78 | $20,392.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $675.00 / $2,690.00 / $12,088.65
| Facility | | $675.00 | $2,690.00 | $12,088.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,602.07 / $12,145.39 / $23,639.51
| Facility | | $7,602.07 | $12,145.39 | $23,639.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,796.00 / $27,492.40 / $27,492.40
| Facility | | $16,796.00 | $27,492.40 | $27,492.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,774.95 / $11,080.68 / $26,371.72
| Facility | | $7,774.95 | $11,080.68 | $26,371.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,390.56 / $11,741.00 / $25,012.47
| Facility | | $4,390.56 | $11,741.00 | $25,012.47 |