- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,487.00 / $9,460.28 / $13,000.60
| Facility | | $6,487.00 | $9,460.28 | $13,000.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,611.76 / $6,611.76 / $7,013.71
| Facility | | $6,611.76 | $6,611.76 | $7,013.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,377.28 / $8,352.64 / $12,651.52
| Facility | | $5,377.28 | $8,352.64 | $12,651.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,611.74 / $8,187.50 / $13,103.45
| Facility | | $5,611.74 | $8,187.50 | $13,103.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,176.79 / $7,860.34 / $11,945.46
| Facility | | $6,176.79 | $7,860.34 | $11,945.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,621.27 / $10,403.00 / $14,450.55
| Facility | | $5,621.27 | $10,403.00 | $14,450.55 |