- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,654.68 / $11,234.20 / $19,768.90
| Facility | | $6,654.68 | $11,234.20 | $19,768.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,815.68 / $9,815.68 / $9,815.68
| Facility | | $9,815.68 | $9,815.68 | $9,815.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,866.10 / $11,710.09 / $19,254.13
| Facility | | $7,866.10 | $11,710.09 | $19,254.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,053.47 / $10,355.19 / $14,906.74
| Facility | | $6,053.47 | $10,355.19 | $14,906.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,916.45 / $20,916.45 / $24,547.23
| Facility | | $20,916.45 | $20,916.45 | $24,547.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $9,790.51 / $13,984.62
| Facility | | $1,787.00 | $9,790.51 | $13,984.62 |