- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,587.29 / $12,951.20 / $21,051.20
| Facility | | $7,587.29 | $12,951.20 | $21,051.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,695.26 / $12,758.74 / $14,214.45
| Facility | | $7,695.26 | $12,758.74 | $14,214.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,506.06 / $10,290.37 / $16,234.08
| Facility | | $6,506.06 | $10,290.37 | $16,234.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,467.53 / $13,916.87 / $27,270.79
| Facility | | $6,467.53 | $13,916.87 | $27,270.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,164.00 / $10,898.11 / $14,800.51
| Facility | | $6,164.00 | $10,898.11 | $14,800.51 |