- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,029.87 / $13,369.40 / $17,498.70
| Facility | | $8,029.87 | $13,369.40 | $17,498.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,975.66 / $9,975.66 / $13,768.65
| Facility | | $9,975.66 | $9,975.66 | $13,768.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,033.92 / $11,270.86 / $17,075.59
| Facility | | $7,033.92 | $11,270.86 | $17,075.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,564.00 / $10,579.95 / $18,112.31
| Facility | | $6,564.00 | $10,579.95 | $18,112.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,564.00 / $10,448.65 / $17,140.50
| Facility | | $6,564.00 | $10,448.65 | $17,140.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,145.60 / $13,615.05 / $19,871.91
| Facility | | $7,145.60 | $13,615.05 | $19,871.91 |