- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $9,749.00 / $16,211.30
| Facility | | $4,804.00 | $9,749.00 | $16,211.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,537.21 / $9,537.21 / $9,537.21
| Facility | | $9,537.21 | $9,537.21 | $9,537.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.00 / $2,742.00 / $10,319.00
| Facility | | $688.00 | $2,742.00 | $10,319.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,139.85 / $10,083.00 / $17,289.68
| Facility | | $6,139.85 | $10,083.00 | $17,289.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,864.90 / $21,057.81 / $21,057.81
| Facility | | $12,864.90 | $21,057.81 | $21,057.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38,824.48 / $38,824.48 / $58,080.20
| Facility | | $38,824.48 | $38,824.48 | $58,080.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,290.00 / $8,938.75 / $17,289.68
| Facility | | $6,290.00 | $8,938.75 | $17,289.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,432.48 / $8,009.12 / $18,236.48
| Facility | | $3,432.48 | $8,009.12 | $18,236.48 |