- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,030.26 / $8,428.87 / $13,682.70
| Facility | | $6,030.26 | $8,428.87 | $13,682.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,703.95 / $8,703.95 / $8,703.95
| Facility | | $8,703.95 | $8,703.95 | $8,703.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,616.15 / $17,935.74 / $22,994.54
| Facility | | $12,616.15 | $17,935.74 | $22,994.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,786.84 / $13,121.73 / $16,596.61
| Facility | | $6,786.84 | $13,121.73 | $16,596.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,030.26 / $9,064.65 / $14,494.80
| Facility | | $6,030.26 | $9,064.65 | $14,494.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,052.32 / $12,059.55 / $18,321.97
| Facility | | $7,052.32 | $12,059.55 | $18,321.97 |