- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,888.10 / $12,688.10 / $21,065.20
| Facility | | $9,888.10 | $12,688.10 | $21,065.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,720.74 / $11,713.36 / $19,593.25
| Facility | | $7,720.74 | $11,713.36 | $19,593.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,936.74 / $13,546.00 / $19,981.00
| Facility | | $10,936.74 | $13,546.00 | $19,981.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,798.75 / $13,586.62 / $34,524.11
| Facility | | $6,798.75 | $13,586.62 | $34,524.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,798.75 / $12,972.02 / $18,231.53
| Facility | | $6,798.75 | $12,972.02 | $18,231.53 |