- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,642.09 / $13,434.20 / $18,832.80
| Facility | | $8,642.09 | $13,434.20 | $18,832.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,075.49 / $13,448.62 / $19,658.24
| Facility | | $11,075.49 | $13,448.62 | $19,658.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,848.22 / $12,750.11 / $19,856.20
| Facility | | $7,848.22 | $12,750.11 | $19,856.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,564.00 / $11,386.60 / $19,493.24
| Facility | | $6,564.00 | $11,386.60 | $19,493.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,564.00 / $11,911.80 / $18,447.34
| Facility | | $6,564.00 | $11,911.80 | $18,447.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,264.00 / $14,781.80 / $21,387.00
| Facility | | $7,264.00 | $14,781.80 | $21,387.00 |