- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,673.40 / $12,954.00 / $22,795.20
| Facility | | $7,673.40 | $12,954.00 | $22,795.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,884.00 / $11,061.27 / $25,438.06
| Facility | | $7,884.00 | $11,061.27 | $25,438.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,785.59 / $7,080.96 / $11,713.86
| Facility | | $4,785.59 | $7,080.96 | $11,713.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,980.16 / $11,940.39 / $16,784.38
| Facility | | $6,980.16 | $11,940.39 | $16,784.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,456.85 / $24,456.85 / $28,702.19
| Facility | | $24,456.85 | $24,456.85 | $28,702.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $11,289.27 / $16,125.43
| Facility | | $1,787.00 | $11,289.27 | $16,125.43 |