- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,913.75 / $11,671.50 / $20,538.59
| Facility | | $6,913.75 | $11,671.50 | $20,538.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,545.88 / $9,583.44 / $15,738.03
| Facility | | $6,545.88 | $9,583.44 | $15,738.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,289.13 / $10,758.32 / $15,487.06
| Facility | | $6,289.13 | $10,758.32 | $15,487.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,128.45 / $21,128.45 / $24,796.03
| Facility | | $21,128.45 | $21,128.45 | $24,796.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $10,171.65 / $14,529.04
| Facility | | $1,787.00 | $10,171.65 | $14,529.04 |