- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,002.00 / $16,452.48 / $27,605.80
| Facility | | $4,002.00 | $16,452.48 | $27,605.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,812.00 / $5,812.00 / $6,916.00
| Facility | | $5,812.00 | $5,812.00 | $6,916.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,008.60 / $19,355.38 / $23,161.54
| Facility | | $13,008.60 | $19,355.38 | $23,161.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,400.00 / $14,696.50 / $21,161.10
| Facility | | $2,400.00 | $14,696.50 | $21,161.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,034.00 / $17,734.09 / $26,251.50
| Facility | | $3,034.00 | $17,734.09 | $26,251.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,500.00 / $2,388.00 / $14,705.15
| Facility | | $1,500.00 | $2,388.00 | $14,705.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,775.00 / $18,823.75 / $27,116.05
| Facility | | $3,775.00 | $18,823.75 | $27,116.05 |