- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,002.00 / $15,778.56 / $25,380.50
| Facility | | $4,002.00 | $15,778.56 | $25,380.50 |
- 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
- $13,015.80 / $17,988.06 / $21,586.66
| Facility | | $13,015.80 | $17,988.06 | $21,586.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,400.00 / $14,059.00 / $19,474.57
| Facility | | $2,400.00 | $14,059.00 | $19,474.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,155.43 / $18,313.25 / $26,266.92
| Facility | | $10,155.43 | $18,313.25 | $26,266.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,500.00 / $2,143.00 / $14,067.27
| Facility | | $1,500.00 | $2,143.00 | $14,067.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,775.00 / $17,306.41 / $24,930.27
| Facility | | $3,775.00 | $17,306.41 | $24,930.27 |