- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,067.01 / $13,618.50 / $23,964.50
| Facility | | $8,067.01 | $13,618.50 | $23,964.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,628.00 / $5,256.00 / $13,477.29
| Facility | | $2,628.00 | $5,256.00 | $13,477.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,766.66 / $8,651.98 / $14,115.27
| Facility | | $5,766.66 | $8,651.98 | $14,115.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,338.21 / $12,552.89 / $17,467.09
| Facility | | $7,338.21 | $12,552.89 | $17,467.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,604.30 / $25,604.30 / $30,048.82
| Facility | | $25,604.30 | $25,604.30 | $30,048.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $11,868.36 / $16,952.59
| Facility | | $1,787.00 | $11,868.36 | $16,952.59 |