- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,834.45 / $10,687.30 / $15,132.10
| Facility | | $5,834.45 | $10,687.30 | $15,132.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,520.23 / $6,520.23 / $6,520.23
| Facility | | $6,520.23 | $6,520.23 | $6,520.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,726.97 / $10,987.59 / $17,789.43
| Facility | | $6,726.97 | $10,987.59 | $17,789.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,066.06 / $12,279.18 / $17,104.45
| Facility | | $6,066.06 | $12,279.18 | $17,104.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,503.59 / $9,070.60 / $20,226.05
| Facility | | $4,503.59 | $9,070.60 | $20,226.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $8,872.99 / $18,670.62
| Facility | | $3,308.00 | $8,872.99 | $18,670.62 |