- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $13,807.00 / $21,767.70
| Facility | | $4,804.00 | $13,807.00 | $21,767.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,485.35 / $14,830.98 / $18,886.29
| Facility | | $9,485.35 | $14,830.98 | $18,886.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $577.00 / $1,187.00 / $2,495.00
| Facility | | $577.00 | $1,187.00 | $2,495.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,641.79 / $20,422.49 / $28,864.57
| Facility | | $8,641.79 | $20,422.49 | $28,864.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,213.40 / $29,812.46 / $29,812.46
| Facility | | $18,213.40 | $29,812.46 | $29,812.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,566.62 / $35,510.19 / $43,030.97
| Facility | | $10,566.62 | $35,510.19 | $43,030.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,681.60 / $10,370.16 / $28,864.57
| Facility | | $7,681.60 | $10,370.16 | $28,864.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,800.00 / $10,754.24 / $24,487.02
| Facility | | $3,800.00 | $10,754.24 | $24,487.02 |