- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $11,239.00 / $17,673.50
| Facility | | $4,804.00 | $11,239.00 | $17,673.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,351.37 / $12,611.67 / $16,372.19
| Facility | | $8,351.37 | $12,611.67 | $16,372.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $682.00 / $2,730.96 / $11,460.37
| Facility | | $682.00 | $2,730.96 | $11,460.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,693.65 / $10,992.00 / $18,849.16
| Facility | | $6,693.65 | $10,992.00 | $18,849.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,825.70 / $24,267.33 / $24,267.33
| Facility | | $14,825.70 | $24,267.33 | $24,267.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,692.00 / $14,340.33 / $32,080.90
| Facility | | $2,692.00 | $14,340.33 | $32,080.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,883.87 / $9,745.00 / $18,849.16
| Facility | | $6,883.87 | $9,745.00 | $18,849.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,742.08 / $8,731.52 / $19,881.36
| Facility | | $3,742.08 | $8,731.52 | $19,881.36 |