- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,688.75 / $10,835.90 / $13,084.10
| Facility | | $5,688.75 | $10,835.90 | $13,084.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,689.97 / $9,784.65 / $16,219.22
| Facility | | $6,689.97 | $9,784.65 | $16,219.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,058.60 / $9,898.42 / $12,496.34
| Facility | | $8,058.60 | $9,898.42 | $12,496.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,420.27 / $8,098.80 / $10,753.60
| Facility | | $5,420.27 | $8,098.80 | $10,753.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,387.05 / $9,867.70 / $14,729.95
| Facility | | $7,387.05 | $9,867.70 | $14,729.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,150.67 / $8,503.79 / $12,098.68
| Facility | | $6,150.67 | $8,503.79 | $12,098.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,775.00 / $8,921.78 / $12,852.02
| Facility | | $3,775.00 | $8,921.78 | $12,852.02 |