- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $9,685.00 / $15,667.20
| Facility | | $4,804.00 | $9,685.00 | $15,667.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,937.77 / $7,937.77 / $7,937.77
| Facility | | $7,937.77 | $7,937.77 | $7,937.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.00 / $2,667.32 / $9,694.66
| Facility | | $688.00 | $2,667.32 | $9,694.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,933.78 / $9,745.00 / $16,709.41
| Facility | | $5,933.78 | $9,745.00 | $16,709.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,775.60 / $20,911.64 / $20,911.64
| Facility | | $12,775.60 | $20,911.64 | $20,911.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,079.00 / $8,638.75 / $16,709.41
| Facility | | $6,079.00 | $8,638.75 | $16,709.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,317.28 / $7,740.32 / $17,624.43
| Facility | | $3,317.28 | $7,740.32 | $17,624.43 |