- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $9,025.00 / $14,082.60
| Facility | | $4,804.00 | $9,025.00 | $14,082.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,971.32 / $10,082.40 / $12,540.02
| Facility | | $4,971.32 | $10,082.40 | $12,540.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.00 / $2,587.00 / $9,034.32
| Facility | | $688.00 | $2,587.00 | $9,034.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,333.62 / $8,759.00 / $16,054.29
| Facility | | $5,333.62 | $8,759.00 | $16,054.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,905.40 / $19,487.25 / $19,487.25
| Facility | | $11,905.40 | $19,487.25 | $19,487.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,335.69 / $21,553.70 / $27,010.82
| Facility | | $16,335.69 | $21,553.70 | $27,010.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,464.00 / $7,765.00 / $16,974.00
| Facility | | $5,464.00 | $7,765.00 | $16,974.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,981.76 / $6,957.44 / $15,906.45
| Facility | | $2,981.76 | $6,957.44 | $15,906.45 |