- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,032.12 / $7,740.23 / $12,850.60
| Facility | | $6,032.12 | $7,740.23 | $12,850.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,976.00 / $6,937.60 / $14,940.00
| Facility | | $5,976.00 | $6,937.60 | $14,940.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,453.16 / $6,814.08 / $11,516.80
| Facility | | $4,453.16 | $6,814.08 | $11,516.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,671.83 / $8,255.85 / $12,091.00
| Facility | | $6,671.83 | $8,255.85 | $12,091.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,147.50 / $8,322.20 / $19,904.00
| Facility | | $4,147.50 | $8,322.20 | $19,904.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,147.50 / $8,111.85 / $11,121.94
| Facility | | $4,147.50 | $8,111.85 | $11,121.94 |