- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,002.00 / $15,164.16 / $30,871.80
| Facility | | $4,002.00 | $15,164.16 | $30,871.80 |
- 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
- $12,463.20 / $21,405.10 / $26,114.62
| Facility | | $12,463.20 | $21,405.10 | $26,114.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,400.00 / $14,001.20 / $21,236.15
| Facility | | $2,400.00 | $14,001.20 | $21,236.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,034.00 / $17,644.70 / $25,830.75
| Facility | | $3,034.00 | $17,644.70 | $25,830.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,500.00 / $2,388.00 / $14,009.44
| Facility | | $1,500.00 | $2,388.00 | $14,009.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,884.00 / $23,864.13 / $29,099.98
| Facility | | $13,884.00 | $23,864.13 | $29,099.98 |