- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $19,620.00 / $31,450.10
| Facility | | $4,804.00 | $19,620.00 | $31,450.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.00 / $3,030.00 / $19,809.20
| Facility | | $688.00 | $3,030.00 | $19,809.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,792.05 / $18,728.55 / $36,569.23
| Facility | | $11,792.05 | $18,728.55 | $36,569.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,883.70 / $42,367.53 / $42,367.53
| Facility | | $25,883.70 | $42,367.53 | $42,367.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,249.86 / $17,147.03 / $39,997.25
| Facility | | $12,249.86 | $17,147.03 | $39,997.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,410.47 / $14,950.93 / $30,902.11
| Facility | | $5,410.47 | $14,950.93 | $30,902.11 |