- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,719.53 / $9,655.52 / $16,990.90
| Facility | | $5,719.53 | $9,655.52 | $16,990.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,062.45 / $9,029.04 / $11,079.16
| Facility | | $5,062.45 | $9,029.04 | $11,079.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,174.13 / $9,263.32 / $14,966.49
| Facility | | $6,174.13 | $9,263.32 | $14,966.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,202.81 / $8,900.03 / $12,811.97
| Facility | | $5,202.81 | $8,900.03 | $12,811.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,239.95 / $18,239.95 / $21,406.13
| Facility | | $18,239.95 | $18,239.95 | $21,406.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $8,414.70 / $12,019.43
| Facility | | $1,787.00 | $8,414.70 | $12,019.43 |