- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $12,738.00 / $19,430.50
| Facility | | $4,804.00 | $12,738.00 | $19,430.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,341.83 / $13,387.13 / $19,904.16
| Facility | | $6,341.83 | $13,387.13 | $19,904.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $675.00 / $2,587.00 / $11,465.47
| Facility | | $675.00 | $2,587.00 | $11,465.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,359.06 / $11,607.71 / $20,722.96
| Facility | | $7,359.06 | $11,607.71 | $20,722.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,807.40 / $27,511.06 / $27,511.06
| Facility | | $16,807.40 | $27,511.06 | $27,511.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,912.79 / $21,074.36 / $81,120.00
| Facility | | $9,912.79 | $21,074.36 | $81,120.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,539.00 / $10,713.75 / $20,722.96
| Facility | | $7,539.00 | $10,713.75 | $20,722.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,775.00 / $9,599.52 / $21,946.90
| Facility | | $3,775.00 | $9,599.52 | $21,946.90 |