- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,103.84 / $10,669.10 / $17,713.20
| Facility | | $7,103.84 | $10,669.10 | $17,713.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,412.66 / $6,412.66 / $6,412.66
| Facility | | $6,412.66 | $6,412.66 | $6,412.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,148.22 / $9,210.39 / $15,602.60
| Facility | | $6,148.22 | $9,210.39 | $15,602.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,196.39 / $11,887.44 / $17,364.00
| Facility | | $9,196.39 | $11,887.44 | $17,364.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,640.49 / $11,471.25 / $19,625.00
| Facility | | $7,640.49 | $11,471.25 | $19,625.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,716.88 / $11,450.00 / $19,499.00
| Facility | | $5,716.88 | $11,450.00 | $19,499.00 |