- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $16,674.00 / $26,147.60
| Facility | | $4,804.00 | $16,674.00 | $26,147.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,843.03 / $24,865.78 / $35,099.51
| Facility | | $16,843.03 | $24,865.78 | $35,099.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.00 / $3,027.00 / $17,542.68
| Facility | | $688.00 | $3,027.00 | $17,542.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,903.09 / $16,263.00 / $27,886.91
| Facility | | $9,903.09 | $16,263.00 | $27,886.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,996.30 / $36,004.47 / $36,004.47
| Facility | | $21,996.30 | $36,004.47 | $36,004.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,184.52 / $14,417.50 / $27,886.91
| Facility | | $10,184.52 | $14,417.50 | $27,886.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,498.26 / $12,918.08 / $29,533.96
| Facility | | $4,498.26 | $12,918.08 | $29,533.96 |