- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,485.00 / $13,513.40 / $22,367.70
| Facility | | $6,485.00 | $13,513.40 | $22,367.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,613.00 / $20,052.70 / $30,697.61
| Facility | | $1,613.00 | $20,052.70 | $30,697.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,196.82 / $17,950.36 / $28,700.73
| Facility | | $14,196.82 | $17,950.36 | $28,700.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,063.76 / $19,337.75 / $40,551.89
| Facility | | $10,063.76 | $19,337.75 | $40,551.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,196.82 / $19,210.06 / $28,707.82
| Facility | | $14,196.82 | $19,210.06 | $28,707.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,870.00 / $15,806.00 / $24,690.50
| Facility | | $4,870.00 | $15,806.00 | $24,690.50 |