- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,852.04 / $8,792.32 / $14,597.30
| Facility | | $6,852.04 | $8,792.32 | $14,597.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,824.81 / $8,725.91 / $14,781.87
| Facility | | $5,824.81 | $8,725.91 | $14,781.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,578.71 / $9,500.00 / $14,013.00
| Facility | | $7,578.71 | $9,500.00 | $14,013.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,711.25 / $9,414.95 / $26,046.25
| Facility | | $4,711.25 | $9,414.95 | $26,046.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,711.25 / $9,214.45 / $12,633.69
| Facility | | $4,711.25 | $9,214.45 | $12,633.69 |