- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $9,518.87 / $14,372.80
| Facility | | $4,804.00 | $9,518.87 | $14,372.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.00 / $2,690.00 / $10,156.04
| Facility | | $688.00 | $2,690.00 | $10,156.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,384.00 / $8,460.10 / $16,712.24
| Facility | | $5,384.00 | $8,460.10 | $16,712.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,383.60 / $21,906.84 / $21,906.84
| Facility | | $13,383.60 | $21,906.84 | $21,906.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,705.37 / $7,868.88 / $18,278.84
| Facility | | $5,705.37 | $7,868.88 | $18,278.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,043.20 / $7,100.80 / $16,234.20
| Facility | | $3,043.20 | $7,100.80 | $16,234.20 |