- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.80 / $7,479.50 / $12,141.60
| Facility | | $5,128.80 | $7,479.50 | $12,141.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,877.87 / $11,877.87 / $11,877.87
| Facility | | $11,877.87 | $11,877.87 | $11,877.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,016.41 / $12,818.17 / $16,433.55
| Facility | | $9,016.41 | $12,818.17 | $16,433.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,022.42 / $11,643.78 / $14,727.27
| Facility | | $6,022.42 | $11,643.78 | $14,727.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,351.05 / $8,043.67 / $12,862.20
| Facility | | $5,351.05 | $8,043.67 | $12,862.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,257.99 / $10,701.24 / $16,258.30
| Facility | | $6,257.99 | $10,701.24 | $16,258.30 |