- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,939.20 / $7,203.00 / $11,692.70
| Facility | | $4,939.20 | $7,203.00 | $11,692.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,030.39 / $19,946.30 / $25,572.18
| Facility | | $14,030.39 | $19,946.30 | $25,572.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,799.78 / $11,213.33 / $14,182.84
| Facility | | $5,799.78 | $11,213.33 | $14,182.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,153.22 / $7,746.31 / $12,386.70
| Facility | | $5,153.22 | $7,746.31 | $12,386.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,026.65 / $10,305.64 / $15,657.26
| Facility | | $6,026.65 | $10,305.64 | $15,657.26 |