- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,396.00 / $11,911.10 / $16,481.90
| Facility | | $6,396.00 | $11,911.10 | $16,481.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,657.28 / $9,657.28 / $9,657.28
| Facility | | $9,657.28 | $9,657.28 | $9,657.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,612.07 / $12,200.07 / $18,479.12
| Facility | | $7,612.07 | $12,200.07 | $18,479.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,564.00 / $9,965.20 / $16,612.31
| Facility | | $6,564.00 | $9,965.20 | $16,612.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,564.00 / $9,700.19 / $15,144.24
| Facility | | $6,564.00 | $9,700.19 | $15,144.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,730.40 / $13,099.35 / $18,320.15
| Facility | | $6,730.40 | $13,099.35 | $18,320.15 |