- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,250.46 / $11,712.90 / $16,207.60
| Facility | | $7,250.46 | $11,712.90 | $16,207.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,847.88 / $11,847.88 / $11,847.88
| Facility | | $11,847.88 | $11,847.88 | $11,847.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,566.56 / $10,403.17 / $15,761.02
| Facility | | $6,566.56 | $10,403.17 | $15,761.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,564.00 / $9,799.37 / $16,335.87
| Facility | | $6,564.00 | $9,799.37 | $16,335.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,564.00 / $9,799.37 / $14,892.23
| Facility | | $6,564.00 | $9,799.37 | $14,892.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,935.83 / $11,851.07 / $17,613.22
| Facility | | $5,935.83 | $11,851.07 | $17,613.22 |