- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,487.21 / $10,051.20 / $14,231.50
| Facility | | $5,487.21 | $10,051.20 | $14,231.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,016.22 / $11,016.22 / $11,016.22
| Facility | | $11,016.22 | $11,016.22 | $11,016.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,277.07 / $10,137.11 / $16,246.25
| Facility | | $6,277.07 | $10,137.11 | $16,246.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,705.04 / $9,041.62 / $16,086.48
| Facility | | $5,705.04 | $9,041.62 | $16,086.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,235.56 / $8,639.68 / $19,022.30
| Facility | | $4,235.56 | $8,639.68 | $19,022.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $8,344.92 / $16,904.21
| Facility | | $3,308.00 | $8,344.92 | $16,904.21 |