- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,373.00 / $7,835.63 / $12,719.70
| Facility | | $5,373.00 | $7,835.63 | $12,719.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,522.90 / $10,522.90 / $10,641.41
| Facility | | $10,522.90 | $10,522.90 | $10,641.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,309.07 / $16,077.53 / $20,612.22
| Facility | | $11,309.07 | $16,077.53 | $20,612.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.16 / $12,198.18 / $15,428.49
| Facility | | $6,309.16 | $12,198.18 | $15,428.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,605.83 / $8,426.66 / $13,474.60
| Facility | | $5,605.83 | $8,426.66 | $13,474.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,555.96 / $11,210.76 / $17,032.41
| Facility | | $6,555.96 | $11,210.76 | $17,032.41 |