- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,704.76 / $12,281.50 / $17,389.30
| Facility | | $6,704.76 | $12,281.50 | $17,389.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,591.76 / $10,591.76 / $13,076.82
| Facility | | $10,591.76 | $10,591.76 | $13,076.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,205.98 / $11,590.85 / $18,522.07
| Facility | | $7,205.98 | $11,590.85 | $18,522.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,970.92 / $11,047.85 / $19,655.88
| Facility | | $6,970.92 | $11,047.85 | $19,655.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,175.38 / $10,449.99 / $23,243.12
| Facility | | $5,175.38 | $10,449.99 | $23,243.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $10,196.54 / $20,655.05
| Facility | | $3,308.00 | $10,196.54 | $20,655.05 |