- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,004.79 / $14,971.00 / $21,192.00
| Facility | | $9,004.79 | $14,971.00 | $21,192.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,702.32 / $11,702.32 / $11,702.32
| Facility | | $11,702.32 | $11,702.32 | $11,702.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,286.31 / $13,277.64 / $20,115.91
| Facility | | $8,286.31 | $13,277.64 | $20,115.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,568.31 / $11,847.37 / $20,282.06
| Facility | | $6,568.31 | $11,847.37 | $20,282.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,568.31 / $11,700.34 / $18,004.59
| Facility | | $6,568.31 | $11,700.34 | $18,004.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,616.32 / $15,246.05 / $21,780.36
| Facility | | $6,616.32 | $15,246.05 | $21,780.36 |