- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,337.00 / $1,337.00 / $25,230.20
| Facility | | $1,337.00 | $1,337.00 | $25,230.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.00 / $19,727.63 / $36,880.90
| Facility | | $1,346.00 | $19,727.63 | $36,880.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,891.65 / $3,907.06 / $18,903.57
| Facility | | $2,891.65 | $3,907.06 | $18,903.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,577.13 / $24,993.55 / $40,910.83
| Facility | | $15,577.13 | $24,993.55 | $40,910.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,834.95 / $5,834.95 / $5,834.95
| Facility | | $5,834.95 | $5,834.95 | $5,834.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $232.10 / $14,602.07 / $20,895.79
| Facility | | $232.10 | $14,602.07 | $20,895.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,726.02 / $24,692.57 / $29,019.96
| Facility | | $17,726.02 | $24,692.57 | $29,019.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,997.72 / $26,338.23 / $33,201.48
| Facility | | $15,997.72 | $26,338.23 | $33,201.48 |