- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $10,917.00 / $16,639.80
| Facility | | $4,804.00 | $10,917.00 | $16,639.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,778.12 / $11,778.12 / $11,778.12
| Facility | | $11,778.12 | $11,778.12 | $11,778.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.00 / $2,753.00 / $10,928.84
| Facility | | $688.00 | $2,753.00 | $10,928.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,302.12 / $9,940.56 / $17,746.65
| Facility | | $6,302.12 | $9,940.56 | $17,746.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,402.00 / $23,573.80 / $23,573.80
| Facility | | $14,402.00 | $23,573.80 | $23,573.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.00 / $9,175.00 / $17,746.65
| Facility | | $6,456.00 | $9,175.00 | $17,746.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,523.20 / $8,220.79 / $18,794.80
| Facility | | $3,523.20 | $8,220.79 | $18,794.80 |