- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $13,787.00 / $23,613.10
| Facility | | $4,804.00 | $13,787.00 | $23,613.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.00 / $2,914.00 / $14,560.72
| Facility | | $688.00 | $2,914.00 | $14,560.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,943.18 / $14,106.39 / $25,183.80
| Facility | | $8,943.18 | $14,106.39 | $25,183.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,175.40 / $29,750.26 / $29,750.26
| Facility | | $18,175.40 | $29,750.26 | $29,750.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,170.56 / $13,020.00 / $25,183.80
| Facility | | $9,170.56 | $13,020.00 | $25,183.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,062.24 / $11,458.64 / $26,562.88
| Facility | | $4,062.24 | $11,458.64 | $26,562.88 |