- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,690.61 / $11,294.90 / $19,875.70
| Facility | | $6,690.61 | $11,294.90 | $19,875.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,791.43 / $11,791.43 / $11,791.43
| Facility | | $11,791.43 | $11,791.43 | $11,791.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,885.58 / $8,761.74 / $14,406.35
| Facility | | $5,885.58 | $8,761.74 | $14,406.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,086.16 / $10,411.11 / $14,987.23
| Facility | | $6,086.16 | $10,411.11 | $14,987.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,856.45 / $19,856.45 / $23,303.23
| Facility | | $19,856.45 | $19,856.45 | $23,303.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $9,843.37 / $14,060.14
| Facility | | $1,787.00 | $9,843.37 | $14,060.14 |