- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $8,989.00 / $13,985.10
| Facility | | $4,804.00 | $8,989.00 | $13,985.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,359.39 / $9,115.78 / $12,738.14
| Facility | | $4,359.39 | $9,115.78 | $12,738.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $561.00 / $1,175.00 / $2,500.00
| Facility | | $561.00 | $1,175.00 | $2,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,552.10 / $13,120.85 / $18,544.63
| Facility | | $5,552.10 | $13,120.85 | $18,544.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,857.90 / $19,409.50 / $19,409.50
| Facility | | $11,857.90 | $19,409.50 | $19,409.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,935.20 / $6,662.52 / $18,544.63
| Facility | | $4,935.20 | $6,662.52 | $18,544.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,961.12 / $6,909.28 / $15,732.18
| Facility | | $2,961.12 | $6,909.28 | $15,732.18 |