- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,212.17 / $10,814.60 / $14,506.80
| Facility | | $5,212.17 | $10,814.60 | $14,506.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,833.31 / $7,833.31 / $22,332.40
| Facility | | $7,833.31 | $7,833.31 | $22,332.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,897.00 / $11,629.22 / $13,827.69
| Facility | | $3,897.00 | $11,629.22 | $13,827.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,192.41 / $11,167.25 / $17,576.91
| Facility | | $9,192.41 | $11,167.25 | $17,576.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $13,796.84 / $19,795.41
| Facility | | $1,350.00 | $13,796.84 | $19,795.41 |