- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $11,317.60 / $17,088.59
| Facility | | $4,804.00 | $11,317.60 | $17,088.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $687.00 / $2,753.00 / $12,231.52
| Facility | | $687.00 | $2,753.00 | $12,231.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,472.13 / $10,629.00 / $19,870.16
| Facility | | $6,472.13 | $10,629.00 | $19,870.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,912.50 / $26,046.25 / $26,046.25
| Facility | | $15,912.50 | $26,046.25 | $26,046.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,656.05 / $9,422.50 / $21,732.81
| Facility | | $6,656.05 | $9,422.50 | $21,732.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,618.24 / $8,442.56 / $19,301.80
| Facility | | $3,618.24 | $8,442.56 | $19,301.80 |