- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $12,752.90 / $19,255.90
| Facility | | $4,804.00 | $12,752.90 | $19,255.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,497.72 / $12,497.72 / $16,374.93
| Facility | | $12,497.72 | $12,497.72 | $16,374.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $687.00 / $2,767.00 / $13,285.70
| Facility | | $687.00 | $2,767.00 | $13,285.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,428.00 / $12,625.00 / $21,951.89
| Facility | | $7,428.00 | $12,625.00 | $21,951.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,559.10 / $25,467.79 / $25,467.79
| Facility | | $15,559.10 | $25,467.79 | $25,467.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,500.20 / $10,617.50 / $22,306.00
| Facility | | $7,500.20 | $10,617.50 | $22,306.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,775.00 / $9,513.28 / $21,749.74
| Facility | | $3,775.00 | $9,513.28 | $21,749.74 |