- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,416.50 / $9,430.00 / $14,559.10
| Facility | | $6,416.50 | $9,430.00 | $14,559.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,451.08 / $12,385.44 / $12,448.52
| Facility | | $11,451.08 | $12,385.44 | $12,448.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,901.72 / $16,920.07 / $21,692.40
| Facility | | $11,901.72 | $16,920.07 | $21,692.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,221.55 / $13,962.18 / $17,659.63
| Facility | | $7,221.55 | $13,962.18 | $17,659.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,416.50 / $9,645.25 / $15,423.20
| Facility | | $6,416.50 | $9,645.25 | $15,423.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,504.03 / $12,831.98 / $19,495.50
| Facility | | $7,504.03 | $12,831.98 | $19,495.50 |