- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $14,629.60 / $22,089.60
| Facility | | $4,804.00 | $14,629.60 | $22,089.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,791.68 / $14,791.68 / $14,791.68
| Facility | | $14,791.68 | $14,791.68 | $14,791.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.00 / $2,990.00 / $14,702.03
| Facility | | $688.00 | $2,990.00 | $14,702.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,366.20 / $13,574.37 / $23,559.04
| Facility | | $8,366.20 | $13,574.37 | $23,559.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,374.30 / $31,712.67 / $31,712.67
| Facility | | $19,374.30 | $31,712.67 | $31,712.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,603.95 / $12,180.00 / $23,559.04
| Facility | | $8,603.95 | $12,180.00 | $23,559.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,019.40 / $10,913.28 / $24,950.49
| Facility | | $4,019.40 | $10,913.28 | $24,950.49 |