- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,863.89 / $10,683.80 / $16,176.00
| Facility | | $7,863.89 | $10,683.80 | $16,176.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,534.46 / $4,534.46 / $4,534.46
| Facility | | $4,534.46 | $4,534.46 | $4,534.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,222.43 / $9,896.07 / $15,010.35
| Facility | | $6,222.43 | $9,896.07 | $15,010.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,860.23 / $9,470.95 / $17,142.00
| Facility | | $6,860.23 | $9,470.95 | $17,142.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $72.92 / $100.91 / $170.09
| Facility | | $72.92 | $100.91 | $170.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,556.19 / $10,457.48 / $17,210.57
| Facility | | $7,556.19 | $10,457.48 | $17,210.57 |