- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,795.21 / $11,148.90 / $16,832.70
| Facility | | $5,795.21 | $11,148.90 | $16,832.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,949.09 / $10,949.09 / $10,949.09
| Facility | | $10,949.09 | $10,949.09 | $10,949.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,044.57 / $12,988.80 / $20,463.28
| Facility | | $8,044.57 | $12,988.80 | $20,463.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,072.56 / $11,208.94 / $19,942.48
| Facility | | $7,072.56 | $11,208.94 | $19,942.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,730.00 / $8,253.19 / $23,582.02
| Facility | | $1,730.00 | $8,253.19 | $23,582.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,500.00 / $6,359.54 / $17,070.59
| Facility | | $1,500.00 | $6,359.54 | $17,070.59 |