- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $12,441.00 / $20,248.80
| Facility | | $4,804.00 | $12,441.00 | $20,248.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,504.16 / $15,236.12 / $20,160.77
| Facility | | $6,504.16 | $15,236.12 | $20,160.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.00 / $2,794.29 / $12,560.52
| Facility | | $688.00 | $2,794.29 | $12,560.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,669.02 / $12,594.00 / $21,595.79
| Facility | | $7,669.02 | $12,594.00 | $21,595.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,412.20 / $26,864.18 / $26,864.18
| Facility | | $16,412.20 | $26,864.18 | $26,864.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,326.08 / $14,294.00 / $16,882.83
| Facility | | $7,326.08 | $14,294.00 | $16,882.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,886.96 / $11,165.00 / $21,595.79
| Facility | | $7,886.96 | $11,165.00 | $21,595.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,800.00 / $10,003.84 / $22,871.28
| Facility | | $3,800.00 | $10,003.84 | $22,871.28 |