- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,013.64 / $9,183.79 / $13,003.30
| Facility | | $5,013.64 | $9,183.79 | $13,003.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,858.05 / $10,858.05 / $10,858.05
| Facility | | $10,858.05 | $10,858.05 | $10,858.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,879.16 / $9,592.76 / $15,479.18
| Facility | | $5,879.16 | $9,592.76 | $15,479.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,212.68 / $8,261.31 / $14,698.18
| Facility | | $5,212.68 | $8,261.31 | $14,698.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,870.02 / $7,896.00 / $17,380.62
| Facility | | $3,870.02 | $7,896.00 | $17,380.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $7,794.54 / $15,445.33
| Facility | | $3,308.00 | $7,794.54 | $15,445.33 |