- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,700.31 / $9,623.07 / $16,933.80
| Facility | | $5,700.31 | $9,623.07 | $16,933.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,623.27 / $9,623.27 / $9,623.27
| Facility | | $9,623.27 | $9,623.27 | $9,623.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,607.35 / $10,771.68 / $17,554.74
| Facility | | $7,607.35 | $10,771.68 | $17,554.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,185.32 / $8,870.12 / $12,768.91
| Facility | | $5,185.32 | $8,870.12 | $12,768.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,091.55 / $18,091.55 / $21,231.97
| Facility | | $18,091.55 | $18,091.55 | $21,231.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $8,386.42 / $11,979.04
| Facility | | $1,787.00 | $8,386.42 | $11,979.04 |