- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,102.56 / $13,830.80 / $22,480.80
| Facility | | $8,102.56 | $13,830.80 | $22,480.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,733.62 / $12,429.79 / $14,539.95
| Facility | | $9,733.62 | $12,429.79 | $14,539.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,989.70 / $10,989.22 / $17,336.55
| Facility | | $6,989.70 | $10,989.22 | $17,336.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,406.39 / $12,683.39 / $24,674.64
| Facility | | $6,406.39 | $12,683.39 | $24,674.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,164.00 / $11,638.22 / $15,805.62
| Facility | | $6,164.00 | $11,638.22 | $15,805.62 |