- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,562.00 / $2,562.00 / $20,439.40
| Facility | | $2,562.00 | $2,562.00 | $20,439.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.00 / $18,472.49 / $28,995.50
| Facility | | $3,162.00 | $18,472.49 | $28,995.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,104.76 / $17,457.62 / $29,702.12
| Facility | | $14,104.76 | $17,457.62 | $29,702.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,522.00 / $19,554.09 / $33,142.51
| Facility | | $1,522.00 | $19,554.09 | $33,142.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,311.00 / $2,477.00 / $3,136.00
| Facility | | $1,311.00 | $2,477.00 | $3,136.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $178.97 / $11,295.63 / $16,138.74
| Facility | | $178.97 | $11,295.63 | $16,138.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,360.13 / $20,003.84 / $23,509.53
| Facility | | $14,360.13 | $20,003.84 | $23,509.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,522.00 / $19,945.15 / $26,897.05
| Facility | | $1,522.00 | $19,945.15 | $26,897.05 |