- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $10,766.00 / $17,038.80
| Facility | | $4,804.00 | $10,766.00 | $17,038.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,330.00 / $10,330.00 / $13,770.42
| Facility | | $10,330.00 | $10,330.00 | $13,770.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.00 / $2,753.00 / $10,817.69
| Facility | | $688.00 | $2,753.00 | $10,817.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,453.24 / $10,178.92 / $18,172.18
| Facility | | $6,453.24 | $10,178.92 | $18,172.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,202.50 / $23,247.25 / $23,247.25
| Facility | | $14,202.50 | $23,247.25 | $23,247.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,691.57 / $28,691.57 / $28,691.57
| Facility | | $28,691.57 | $28,691.57 | $28,691.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,611.00 / $9,395.00 / $18,172.18
| Facility | | $6,611.00 | $9,395.00 | $18,172.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,607.68 / $8,417.92 / $19,245.47
| Facility | | $3,607.68 | $8,417.92 | $19,245.47 |