- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,954.36 / $10,051.90 / $17,688.50
| Facility | | $5,954.36 | $10,051.90 | $17,688.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,183.98 / $11,183.98 / $11,183.98
| Facility | | $11,183.98 | $11,183.98 | $11,183.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,990.76 / $5,890.75 / $9,673.85
| Facility | | $3,990.76 | $5,890.75 | $9,673.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,416.43 / $9,265.44 / $13,338.00
| Facility | | $5,416.43 | $9,265.44 | $13,338.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,457.25 / $18,457.25 / $21,661.15
| Facility | | $18,457.25 | $18,457.25 | $21,661.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $8,582.78 / $12,512.93
| Facility | | $1,787.00 | $8,582.78 | $12,512.93 |