- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $11,679.00 / $18,308.30
| Facility | | $4,804.00 | $11,679.00 | $18,308.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,911.42 / $13,660.98 / $20,235.38
| Facility | | $9,911.42 | $13,660.98 | $20,235.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $675.00 / $2,587.00 / $10,861.68
| Facility | | $675.00 | $2,587.00 | $10,861.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,934.05 / $11,250.68 / $19,526.15
| Facility | | $6,934.05 | $11,250.68 | $19,526.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,798.93 / $39,000.00 / $39,000.00
| Facility | | $14,798.93 | $39,000.00 | $39,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,104.00 / $10,095.00 / $19,526.15
| Facility | | $7,104.00 | $10,095.00 | $19,526.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,775.00 / $9,045.12 / $20,679.41
| Facility | | $3,775.00 | $9,045.12 | $20,679.41 |