- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,798.71 / $12,453.60 / $17,632.90
| Facility | | $6,798.71 | $12,453.60 | $17,632.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,673.09 / $10,673.09 / $10,673.09
| Facility | | $10,673.09 | $10,673.09 | $10,673.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,015.56 / $13,003.84 / $20,962.90
| Facility | | $8,015.56 | $13,003.84 | $20,962.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,068.60 / $11,202.66 / $19,931.31
| Facility | | $7,068.60 | $11,202.66 | $19,931.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,247.90 / $10,867.44 / $23,568.81
| Facility | | $5,247.90 | $10,867.44 | $23,568.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $10,339.43 / $20,944.48
| Facility | | $3,308.00 | $10,339.43 | $20,944.48 |