- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,110.14 / $9,360.54 / $13,253.50
| Facility | | $5,110.14 | $9,360.54 | $13,253.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,064.11 / $8,064.11 / $8,064.11
| Facility | | $8,064.11 | $8,064.11 | $8,064.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,263.65 / $10,129.19 / $16,233.56
| Facility | | $6,263.65 | $10,129.19 | $16,233.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,313.00 / $8,420.29 / $14,981.05
| Facility | | $5,313.00 | $8,420.29 | $14,981.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,944.50 / $7,982.10 / $17,715.12
| Facility | | $3,944.50 | $7,982.10 | $17,715.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $7,944.55 / $15,742.58
| Facility | | $3,308.00 | $7,944.55 | $15,742.58 |