- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $13,032.00 / $20,303.30
| Facility | | $4,804.00 | $13,032.00 | $20,303.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.00 / $2,838.98 / $12,610.89
| Facility | | $688.00 | $2,838.98 | $12,610.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,689.62 / $12,476.60 / $21,653.82
| Facility | | $7,689.62 | $12,476.60 | $21,653.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,191.20 / $28,139.28 / $28,139.28
| Facility | | $17,191.20 | $28,139.28 | $28,139.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,878.00 / $11,195.00 / $21,653.82
| Facility | | $7,878.00 | $11,195.00 | $21,653.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,800.00 / $10,030.71 / $22,932.73
| Facility | | $3,800.00 | $10,030.71 | $22,932.73 |