- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,019.55 / $10,162.00 / $17,882.20
| Facility | | $6,019.55 | $10,162.00 | $17,882.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,824.62 / $5,659.08 / $9,271.12
| Facility | | $3,824.62 | $5,659.08 | $9,271.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,475.72 / $9,366.87 / $13,484.02
| Facility | | $5,475.72 | $9,366.87 | $13,484.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,794.75 / $17,794.75 / $20,883.65
| Facility | | $17,794.75 | $17,794.75 | $20,883.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $8,856.09 / $12,649.91
| Facility | | $1,787.00 | $8,856.09 | $12,649.91 |