- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,572.72 / $12,039.60 / $17,046.80
| Facility | | $6,572.72 | $12,039.60 | $17,046.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,175.15 / $11,175.15 / $11,175.15
| Facility | | $11,175.15 | $11,175.15 | $11,175.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,965.97 / $14,566.31 / $25,414.47
| Facility | | $7,965.97 | $14,566.31 | $25,414.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,833.64 / $13,832.94 / $25,075.32
| Facility | | $6,833.64 | $13,832.94 | $25,075.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,073.46 / $10,218.36 / $22,785.39
| Facility | | $5,073.46 | $10,218.36 | $22,785.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $9,400.50 / $20,248.28
| Facility | | $3,308.00 | $9,400.50 | $20,248.28 |