- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $10,431.00 / $17,916.09
| Facility | | $4,804.00 | $10,431.00 | $17,916.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $687.00 / $2,733.35 / $11,320.69
| Facility | | $687.00 | $2,733.35 | $11,320.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,785.52 / $11,009.67 / $19,107.87
| Facility | | $6,785.52 | $11,009.67 | $19,107.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,759.80 / $22,522.62 / $22,522.62
| Facility | | $13,759.80 | $22,522.62 | $22,522.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,951.00 / $9,878.75 / $19,107.87
| Facility | | $6,951.00 | $9,878.75 | $19,107.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,775.00 / $8,851.36 / $20,236.41
| Facility | | $3,775.00 | $8,851.36 | $20,236.41 |