- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,337.00 / $1,337.00 / $17,113.59
| Facility | | $1,337.00 | $1,337.00 | $17,113.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.00 / $13,060.92 / $24,417.45
| Facility | | $1,346.00 | $13,060.92 | $24,417.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,961.40 / $2,650.15 / $12,822.27
| Facility | | $1,961.40 | $2,650.15 | $12,822.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,565.95 / $16,953.09 / $27,749.78
| Facility | | $10,565.95 | $16,953.09 | $27,749.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,683.67 / $6,683.67 / $6,683.67
| Facility | | $6,683.67 | $6,683.67 | $6,683.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $153.66 / $9,667.48 / $13,834.31
| Facility | | $153.66 | $9,667.48 | $13,834.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,023.54 / $16,748.93 / $19,684.21
| Facility | | $12,023.54 | $16,748.93 | $19,684.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,851.24 / $17,865.18 / $22,520.53
| Facility | | $10,851.24 | $17,865.18 | $22,520.53 |