- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $10,232.93 / $19,054.61
| Facility | | $6,606.93 | $10,232.93 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $10,232.93 / $14,125.38
| Facility | | $6,309.57 | $10,232.93 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $8,709.64 / $13,803.84
| Facility | | $5,623.41 | $8,709.64 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $6,760.83 / $13,803.84
| Facility | | $3,235.94 | $6,760.83 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $9,772.37 / $12,882.50
| Facility | | $5,370.32 | $9,772.37 | $12,882.50 |