- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $10,964.78 / $17,782.79
| Facility | | $7,413.10 | $10,964.78 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,488.17 / $15,488.17 / $15,488.17
| Facility | | $15,488.17 | $15,488.17 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $8,317.64 / $14,454.40
| Facility | | $4,073.80 | $8,317.64 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $11,481.54 / $21,379.62
| Facility | | $6,918.31 | $11,481.54 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,542.29 / $27,542.29 / $27,542.29
| Facility | | $27,542.29 | $27,542.29 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $10,471.29 / $17,782.79
| Facility | | $4,265.80 | $10,471.29 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $10,000.00 / $22,908.68
| Facility | | $6,918.31 | $10,000.00 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $9,332.54 / $20,892.96
| Facility | | $3,801.89 | $9,332.54 | $20,892.96 |