- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $16,454.00 / $25,986.60
| Facility | | $4,804.00 | $16,454.00 | $25,986.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,668.24 / $26,668.24 / $26,668.24
| Facility | | $26,668.24 | $26,668.24 | $26,668.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.00 / $3,030.00 / $16,751.70
| Facility | | $688.00 | $3,030.00 | $16,751.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,842.12 / $15,969.11 / $30,216.47
| Facility | | $9,842.12 | $15,969.11 | $30,216.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,705.60 / $35,528.64 / $35,528.64
| Facility | | $21,705.60 | $35,528.64 | $35,528.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46,566.93 / $46,566.93 / $53,194.44
| Facility | | $46,566.93 | $46,566.93 | $53,194.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,083.00 / $14,328.75 / $33,048.98
| Facility | | $10,083.00 | $14,328.75 | $33,048.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,470.57 / $12,838.56 / $29,352.16
| Facility | | $4,470.57 | $12,838.56 | $29,352.16 |