- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,621.17 / $12,311.80 / $17,036.30
| Facility | | $7,621.17 | $12,311.80 | $17,036.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,140.74 / $9,140.74 / $9,140.74
| Facility | | $9,140.74 | $9,140.74 | $9,140.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,204.92 / $11,544.87 / $17,490.72
| Facility | | $7,204.92 | $11,544.87 | $17,490.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,564.00 / $10,300.41 / $17,171.12
| Facility | | $6,564.00 | $10,300.41 | $17,171.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,564.00 / $10,300.41 / $16,687.62
| Facility | | $6,564.00 | $10,300.41 | $16,687.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,956.80 / $13,468.36 / $18,936.41
| Facility | | $6,956.80 | $13,468.36 | $18,936.41 |