- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,337.00 / $1,337.00 / $19,086.70
| Facility | | $1,337.00 | $1,337.00 | $19,086.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.00 / $16,205.57 / $30,296.39
| Facility | | $1,346.00 | $16,205.57 | $30,296.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.53 / $2,955.68 / $14,300.53
| Facility | | $2,187.53 | $2,955.68 | $14,300.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,784.09 / $18,907.59 / $30,949.01
| Facility | | $11,784.09 | $18,907.59 | $30,949.01 |
- 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
- $190.66 / $11,995.10 / $17,165.16
| Facility | | $190.66 | $11,995.10 | $17,165.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,409.71 / $18,679.90 / $21,953.57
| Facility | | $13,409.71 | $18,679.90 | $21,953.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,102.26 / $19,924.84 / $25,116.89
| Facility | | $12,102.26 | $19,924.84 | $25,116.89 |