- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,861.86 / $8,827.86 / $14,196.90
| Facility | | $6,861.86 | $8,827.86 | $14,196.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,620.90 / $9,620.90 / $13,514.04
| Facility | | $9,620.90 | $9,620.90 | $13,514.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,636.26 / $10,856.09 / $13,918.06
| Facility | | $7,636.26 | $10,856.09 | $13,918.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,483.70 / $8,784.31 / $16,992.00
| Facility | | $4,483.70 | $8,784.31 | $16,992.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,861.86 / $9,065.28 / $15,562.10
| Facility | | $6,861.86 | $9,065.28 | $15,562.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,800.00 / $7,082.00 / $16,245.20
| Facility | | $3,800.00 | $7,082.00 | $16,245.20 |