- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,027.70 / $9,057.75 / $18,407.70
| Facility | | $7,027.70 | $9,057.75 | $18,407.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,648.63 / $9,856.09 / $11,997.56
| Facility | | $6,648.63 | $9,856.09 | $11,997.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,984.98 / $8,755.82 / $10,010.17
| Facility | | $6,984.98 | $8,755.82 | $10,010.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,609.60 / $9,929.59 / $12,913.86
| Facility | | $5,609.60 | $9,929.59 | $12,913.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,328.68 / $11,334.50 / $14,397.07
| Facility | | $8,328.68 | $11,334.50 | $14,397.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,286.00 / $7,963.28 / $12,263.65
| Facility | | $1,286.00 | $7,963.28 | $12,263.65 |