- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,033.93 / $14,594.10 / $20,194.40
| Facility | | $9,033.93 | $14,594.10 | $20,194.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,670.24 / $14,670.24 / $14,670.24
| Facility | | $14,670.24 | $14,670.24 | $14,670.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,488.26 / $13,601.23 / $20,606.16
| Facility | | $8,488.26 | $13,601.23 | $20,606.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,769.26 / $12,209.83 / $20,902.56
| Facility | | $6,769.26 | $12,209.83 | $20,902.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,769.26 / $12,058.30 / $18,555.43
| Facility | | $6,769.26 | $12,058.30 | $18,555.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,818.74 / $15,965.03 / $22,706.46
| Facility | | $6,818.74 | $15,965.03 | $22,706.46 |