- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $17,482.00 / $30,502.50
| Facility | | $4,804.00 | $17,482.00 | $30,502.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.00 / $3,030.00 / $18,975.68
| Facility | | $688.00 | $3,030.00 | $18,975.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,552.46 / $18,972.00 / $35,467.37
| Facility | | $11,552.46 | $18,972.00 | $35,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,064.10 / $37,752.29 / $37,752.29
| Facility | | $23,064.10 | $37,752.29 | $37,752.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,880.77 / $16,818.75 / $38,792.11
| Facility | | $11,880.77 | $16,818.75 | $38,792.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,432.00 / $14,801.85 / $34,312.94
| Facility | | $4,432.00 | $14,801.85 | $34,312.94 |