- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,775.52 / $9,750.04 / $17,157.20
| Facility | | $5,775.52 | $9,750.04 | $17,157.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,942.97 / $7,296.32 / $12,099.11
| Facility | | $4,942.97 | $7,296.32 | $12,099.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,253.74 / $8,987.15 / $12,937.39
| Facility | | $5,253.74 | $8,987.15 | $12,937.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,818.59 / $17,818.59 / $20,911.64
| Facility | | $17,818.59 | $17,818.59 | $20,911.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $8,497.07 / $12,137.10
| Facility | | $1,787.00 | $8,497.07 | $12,137.10 |