- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,395.61 / $11,715.20 / $16,587.50
| Facility | | $6,395.61 | $11,715.20 | $16,587.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,783.33 / $10,783.33 / $10,783.33
| Facility | | $10,783.33 | $10,783.33 | $10,783.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,251.54 / $9,962.34 / $15,728.48
| Facility | | $6,251.54 | $9,962.34 | $15,728.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,649.50 / $10,538.45 / $18,749.58
| Facility | | $6,649.50 | $10,538.45 | $18,749.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,936.75 / $9,726.41 / $22,171.41
| Facility | | $4,936.75 | $9,726.41 | $22,171.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $9,726.41 / $19,702.66
| Facility | | $3,308.00 | $9,726.41 | $19,702.66 |