- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,417.15 / $8,270.84 / $16,808.50
| Facility | | $6,417.15 | $8,270.84 | $16,808.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,541.15 / $7,541.15 / $7,541.15
| Facility | | $7,541.15 | $7,541.15 | $7,541.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,358.76 / $7,970.84 / $9,112.73
| Facility | | $6,358.76 | $7,970.84 | $9,112.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,122.26 / $9,066.94 / $11,791.94
| Facility | | $5,122.26 | $9,066.94 | $11,791.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,672.32 / $8,672.32 / $8,672.32
| Facility | | $8,672.32 | $8,672.32 | $8,672.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,286.00 / $7,271.46 / $11,198.23
| Facility | | $1,286.00 | $7,271.46 | $11,198.23 |