- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,822.00 / $14,957.30 / $17,382.00
| Facility | | $3,822.00 | $14,957.30 | $17,382.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,750.00 / $9,712.64 / $28,136.17
| Facility | | $3,750.00 | $9,712.64 | $28,136.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,451.36 / $13,974.51 / $21,115.65
| Facility | | $8,451.36 | $13,974.51 | $21,115.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,394.00 / $9,637.00 / $19,845.24
| Facility | | $8,394.00 | $9,637.00 | $19,845.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,176.76 / $14,078.06 / $21,739.83
| Facility | | $12,176.76 | $14,078.06 | $21,739.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,750.00 / $9,712.64 / $28,136.17
| Facility | | $3,750.00 | $9,712.64 | $28,136.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,775.00 / $10,896.76 / $20,738.84
| Facility | | $3,775.00 | $10,896.76 | $20,738.84 |