- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,182.57 / $15,488.17 / $16,218.10
| Facility | | $13,182.57 | $15,488.17 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $16,595.87 / $23,988.33
| Facility | | $9,549.93 | $16,595.87 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $13,803.84 / $24,547.09
| Facility | | $10,000.00 | $13,803.84 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $13,182.57 / $16,595.87
| Facility | | $11,481.54 | $13,182.57 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $15,488.17 / $25,118.86
| Facility | | $9,549.93 | $15,488.17 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $10,000.00 / $12,882.50
| Facility | | $109.65 | $10,000.00 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,454.40 / $17,782.79 / $18,620.87
| Facility | | $14,454.40 | $17,782.79 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $16,595.87 / $22,387.21
| Facility | | $9,549.93 | $16,595.87 | $22,387.21 |