- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $8,741.00 / $15,234.20
| Facility | | $4,804.00 | $8,741.00 | $15,234.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.00 / $2,568.03 / $8,924.78
| Facility | | $688.00 | $2,568.03 | $8,924.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,712.00 / $9,100.90 / $16,247.62
| Facility | | $5,712.00 | $9,100.90 | $16,247.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,531.10 / $18,874.59 / $18,874.59
| Facility | | $11,531.10 | $18,874.59 | $18,874.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,911.00 / $8,400.00 / $16,247.62
| Facility | | $5,911.00 | $8,400.00 | $16,247.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,225.60 / $7,526.40 / $17,207.23
| Facility | | $3,225.60 | $7,526.40 | $17,207.23 |