- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $11,822.00 / $17,850.40
| Facility | | $4,804.00 | $11,822.00 | $17,850.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,652.36 / $12,652.36 / $12,823.00
| Facility | | $12,652.36 | $12,652.36 | $12,823.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.00 / $2,914.00 / $12,543.21
| Facility | | $688.00 | $2,914.00 | $12,543.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.62 / $11,102.00 / $20,755.86
| Facility | | $6,760.62 | $11,102.00 | $20,755.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,623.09 / $27,209.39 / $27,209.39
| Facility | | $16,623.09 | $27,209.39 | $27,209.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,210.00 / $1,210.00 / $1,210.00
| Facility | | $1,210.00 | $1,210.00 | $1,210.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,952.74 / $9,842.50 / $22,701.53
| Facility | | $6,952.74 | $9,842.50 | $22,701.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,775.00 / $8,818.87 / $20,162.16
| Facility | | $3,775.00 | $8,818.87 | $20,162.16 |