- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.81 / $11,890.40 / $19,326.80
| Facility | | $6,965.81 | $11,890.40 | $19,326.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,687.00 / $13,747.44 / $15,875.00
| Facility | | $9,687.00 | $13,747.44 | $15,875.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,973.14 / $9,447.48 / $14,904.31
| Facility | | $5,973.14 | $9,447.48 | $14,904.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,101.93 / $9,148.54 / $17,113.86
| Facility | | $5,101.93 | $9,148.54 | $17,113.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,504.25 / $10,137.79 / $13,588.17
| Facility | | $5,504.25 | $10,137.79 | $13,588.17 |