- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $9,672.00 / $16,329.20
| Facility | | $4,804.00 | $9,672.00 | $16,329.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.00 / $2,753.00 / $10,233.66
| Facility | | $688.00 | $2,753.00 | $10,233.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,184.50 / $10,034.50 / $17,415.41
| Facility | | $6,184.50 | $10,034.50 | $17,415.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,758.50 / $20,883.65 / $20,883.65
| Facility | | $12,758.50 | $20,883.65 | $20,883.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,336.00 / $9,003.75 / $17,415.41
| Facility | | $6,336.00 | $9,003.75 | $17,415.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,457.44 / $8,067.36 / $18,369.09
| Facility | | $3,457.44 | $8,067.36 | $18,369.09 |