- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,650.84 / $14,047.00 / $18,850.00
| Facility | | $7,650.84 | $14,047.00 | $18,850.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.39 / $10,300.09 / $11,899.77
| Facility | | $4,241.39 | $10,300.09 | $11,899.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,216.36 / $11,298.29 / $18,077.68
| Facility | | $6,216.36 | $11,298.29 | $18,077.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,953.39 / $11,310.00 / $25,938.35
| Facility | | $6,953.39 | $11,310.00 | $25,938.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,647.00 / $10,978.24 / $15,650.78
| Facility | | $6,647.00 | $10,978.24 | $15,650.78 |