- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,740.41 / $9,975.54 / $13,945.60
| Facility | | $6,740.41 | $9,975.54 | $13,945.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,830.08 / $15,396.58 / $19,739.20
| Facility | | $10,830.08 | $15,396.58 | $19,739.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,518.41 / $12,770.65 / $18,464.22
| Facility | | $6,518.41 | $12,770.65 | $18,464.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,740.41 / $10,850.00 / $15,286.60
| Facility | | $6,740.41 | $10,850.00 | $15,286.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,700.00 / $10,379.44 / $15,957.69
| Facility | | $5,700.00 | $10,379.44 | $15,957.69 |