- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,426.27 / $9,939.61 / $14,073.40
| Facility | | $5,426.27 | $9,939.61 | $14,073.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,577.13 / $10,577.13 / $10,577.13
| Facility | | $10,577.13 | $10,577.13 | $10,577.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,183.71 / $10,013.62 / $15,894.45
| Facility | | $6,183.71 | $10,013.62 | $15,894.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,641.68 / $8,941.20 / $15,907.83
| Facility | | $5,641.68 | $8,941.20 | $15,907.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,188.52 / $8,522.08 / $18,811.04
| Facility | | $4,188.52 | $8,522.08 | $18,811.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $8,291.00 / $16,716.47
| Facility | | $3,308.00 | $8,291.00 | $16,716.47 |