- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,822.00 / $17,382.00 / $18,218.40
| Facility | | $3,822.00 | $17,382.00 | $18,218.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,750.00 / $9,750.00 / $33,021.98
| Facility | | $3,750.00 | $9,750.00 | $33,021.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,844.06 / $16,277.36 / $24,595.29
| Facility | | $9,844.06 | $16,277.36 | $24,595.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,394.00 / $9,637.00 / $23,115.53
| Facility | | $8,394.00 | $9,637.00 | $23,115.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,183.36 / $16,397.97 / $25,322.32
| Facility | | $14,183.36 | $16,397.97 | $25,322.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,750.00 / $9,750.00 / $33,021.98
| Facility | | $3,750.00 | $9,750.00 | $33,021.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,750.00 / $9,116.00 / $18,973.00
| Facility | | $3,750.00 | $9,116.00 | $18,973.00 |