- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,042.78 / $8,880.76 / $13,711.10
| Facility | | $6,042.78 | $8,880.76 | $13,711.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,564.31 / $13,356.75 / $18,687.43
| Facility | | $8,564.31 | $13,356.75 | $18,687.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,192.36 / $17,333.25 / $22,222.13
| Facility | | $12,192.36 | $17,333.25 | $22,222.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,800.93 / $13,148.97 / $16,631.07
| Facility | | $6,800.93 | $13,148.97 | $16,631.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,042.78 / $9,083.46 / $14,524.90
| Facility | | $6,042.78 | $9,083.46 | $14,524.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,066.96 / $12,084.59 / $18,360.00
| Facility | | $7,066.96 | $12,084.59 | $18,360.00 |