- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $12,022.64 / $22,908.68
| Facility | | $6,760.83 | $12,022.64 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $12,589.25 / $12,589.25
| Facility | | $12,589.25 | $12,589.25 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $13,182.57 / $21,877.62
| Facility | | $7,413.10 | $13,182.57 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $8,912.51 / $18,620.87
| Facility | | $100.00 | $8,912.51 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $10,715.19 / $18,620.87
| Facility | | $7,413.10 | $10,715.19 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,877.62 / $21,877.62 / $21,877.62
| Facility | | $21,877.62 | $21,877.62 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $12,022.64 / $21,877.62
| Facility | | $7,413.10 | $12,022.64 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $10,471.29 / $20,892.96
| Facility | | $5,011.87 | $10,471.29 | $20,892.96 |