- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,822.00 / $16,656.40 / $17,605.00
| Facility | | $3,822.00 | $16,656.40 | $17,605.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,400.00 / $9,046.00 / $31,037.80
| Facility | | $3,400.00 | $9,046.00 | $31,037.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,512.62 / $15,729.34 / $23,767.22
| Facility | | $9,512.62 | $15,729.34 | $23,767.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,438.00 / $8,148.00 / $22,337.28
| Facility | | $4,438.00 | $8,148.00 | $22,337.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,705.84 / $15,845.89 / $24,469.78
| Facility | | $13,705.84 | $15,845.89 | $24,469.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,400.00 / $9,046.00 / $31,037.80
| Facility | | $3,400.00 | $9,046.00 | $31,037.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,400.00 / $7,963.00 / $15,374.28
| Facility | | $3,400.00 | $7,963.00 | $15,374.28 |