- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,280.88 / $9,171.95 / $12,055.10
| Facility | | $6,280.88 | $9,171.95 | $12,055.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,929.47 / $7,929.47 / $7,929.47
| Facility | | $7,929.47 | $7,929.47 | $7,929.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,651.09 / $9,943.28 / $16,817.72
| Facility | | $3,651.09 | $9,943.28 | $16,817.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,677.15 / $9,212.70 / $15,420.00
| Facility | | $6,677.15 | $9,212.70 | $15,420.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,900.49 / $10,281.51 / $15,011.84
| Facility | | $7,900.49 | $10,281.51 | $15,011.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,900.49 / $9,558.03 / $15,011.84
| Facility | | $7,900.49 | $9,558.03 | $15,011.84 |