- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,988.96 / $11,798.50 / $20,762.00
| Facility | | $6,988.96 | $11,798.50 | $20,762.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,628.00 / $6,253.22 / $11,206.83
| Facility | | $2,628.00 | $6,253.22 | $11,206.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,360.63 / $6,491.57 / $10,642.75
| Facility | | $4,360.63 | $6,491.57 | $10,642.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,357.55 / $10,875.35 / $15,633.36
| Facility | | $6,357.55 | $10,875.35 | $15,633.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,530.30 / $22,530.30 / $26,441.22
| Facility | | $22,530.30 | $22,530.30 | $26,441.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,158.00 / $10,516.00 / $17,198.50
| Facility | | $3,158.00 | $10,516.00 | $17,198.50 |