- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,822.00 / $14,941.70 / $17,382.00
| Facility | | $3,822.00 | $14,941.70 | $17,382.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,750.00 / $9,702.51 / $27,165.85
| Facility | | $3,750.00 | $9,702.51 | $27,165.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,442.54 / $13,959.94 / $21,093.63
| Facility | | $8,442.54 | $13,959.94 | $21,093.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,394.00 / $9,637.00 / $19,824.54
| Facility | | $8,394.00 | $9,637.00 | $19,824.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,164.06 / $14,063.38 / $21,717.16
| Facility | | $12,164.06 | $14,063.38 | $21,717.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,750.00 / $9,702.51 / $27,165.85
| Facility | | $3,750.00 | $9,702.51 | $27,165.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,139.00 / $8,906.00 / $18,973.00
| Facility | | $3,139.00 | $8,906.00 | $18,973.00 |