- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,281.12 / $10,603.60 / $18,659.20
| Facility | | $6,281.12 | $10,603.60 | $18,659.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,553.93 / $5,553.93 / $10,475.27
| Facility | | $5,553.93 | $5,553.93 | $10,475.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,867.57 / $5,710.55 / $9,389.49
| Facility | | $3,867.57 | $5,710.55 | $9,389.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,713.66 / $9,773.90 / $14,069.95
| Facility | | $5,713.66 | $9,773.90 | $14,069.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,808.75 / $19,808.75 / $23,247.25
| Facility | | $19,808.75 | $19,808.75 | $23,247.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $9,240.92 / $13,199.60
| Facility | | $1,787.00 | $9,240.92 | $13,199.60 |