- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,747.03 / $9,915.76 / $15,309.10
| Facility | | $6,747.03 | $9,915.76 | $15,309.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,629.31 / $11,629.31 / $11,629.31
| Facility | | $11,629.31 | $11,629.31 | $11,629.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,250.21 / $13,150.57 / $16,859.70
| Facility | | $9,250.21 | $13,150.57 | $16,859.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,593.54 / $14,681.40 / $18,569.32
| Facility | | $7,593.54 | $14,681.40 | $18,569.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,747.03 / $10,142.10 / $16,217.70
| Facility | | $6,747.03 | $10,142.10 | $16,217.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,890.57 / $13,492.98 / $20,499.75
| Facility | | $7,890.57 | $13,492.98 | $20,499.75 |