- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $16,242.00 / $25,929.90
| Facility | | $4,804.00 | $16,242.00 | $25,929.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.00 / $3,027.00 / $16,755.88
| Facility | | $688.00 | $3,027.00 | $16,755.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,820.67 / $16,128.00 / $27,654.80
| Facility | | $9,820.67 | $16,128.00 | $27,654.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,428.20 / $35,074.58 / $35,074.58
| Facility | | $21,428.20 | $35,074.58 | $35,074.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,099.75 / $14,297.50 / $27,654.80
| Facility | | $10,099.75 | $14,297.50 | $27,654.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,460.82 / $12,810.56 / $29,288.14
| Facility | | $4,460.82 | $12,810.56 | $29,288.14 |