- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,976.09 / $10,088.60 / $17,753.09
| Facility | | $5,976.09 | $10,088.60 | $17,753.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,078.51 / $7,514.39 / $12,430.86
| Facility | | $5,078.51 | $7,514.39 | $12,430.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,436.19 / $9,299.25 / $13,386.67
| Facility | | $5,436.19 | $9,299.25 | $13,386.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,943.15 / $17,943.15 / $21,057.81
| Facility | | $17,943.15 | $17,943.15 | $21,057.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $8,792.15 / $12,558.59
| Facility | | $1,787.00 | $8,792.15 | $12,558.59 |