- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,879.48 / $11,613.70 / $20,436.80
| Facility | | $6,879.48 | $11,613.70 | $20,436.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,706.03 / $6,701.88 / $11,054.63
| Facility | | $4,706.03 | $6,701.88 | $11,054.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,257.97 / $10,705.00 / $15,410.30
| Facility | | $6,257.97 | $10,705.00 | $15,410.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,718.45 / $22,718.45 / $26,662.03
| Facility | | $22,718.45 | $22,718.45 | $26,662.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $10,121.24 / $14,457.04
| Facility | | $1,787.00 | $10,121.24 | $14,457.04 |