- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,689.78 / $11,293.50 / $19,873.20
| Facility | | $6,689.78 | $11,293.50 | $19,873.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,903.14 / $10,197.01 / $19,908.15
| Facility | | $5,903.14 | $10,197.01 | $19,908.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,121.85 / $5,869.97 / $9,710.54
| Facility | | $4,121.85 | $5,869.97 | $9,710.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,085.40 / $10,409.81 / $14,985.36
| Facility | | $6,085.40 | $10,409.81 | $14,985.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,054.25 / $21,054.25 / $24,708.95
| Facility | | $21,054.25 | $21,054.25 | $24,708.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $9,842.15 / $14,058.38
| Facility | | $1,787.00 | $9,842.15 | $14,058.38 |