- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,160.61 / $7,940.19 / $16,136.60
| Facility | | $6,160.61 | $7,940.19 | $16,136.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,450.54 / $7,450.54 / $7,450.54
| Facility | | $7,450.54 | $7,450.54 | $7,450.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,299.12 / $7,896.08 / $9,027.26
| Facility | | $6,299.12 | $7,896.08 | $9,027.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,917.47 / $8,704.45 / $11,320.53
| Facility | | $4,917.47 | $8,704.45 | $11,320.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,568.12 / $8,568.12 / $8,568.12
| Facility | | $8,568.12 | $8,568.12 | $8,568.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.00 / $7,909.24 / $11,119.36
| Facility | | $1,518.00 | $7,909.24 | $11,119.36 |