- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $12,022.64 / $30,902.95
| Facility | | $4,466.84 | $12,022.64 | $30,902.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $14,791.08 / $16,982.44
| Facility | | $9,120.11 | $14,791.08 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $14,125.38 / $22,387.21
| Facility | | $9,120.11 | $14,125.38 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $10,715.19 / $22,387.21
| Facility | | $7,762.47 | $10,715.19 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $10,000.00 / $19,054.61
| Facility | | $6,606.93 | $10,000.00 | $19,054.61 |