- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,370.80 / $9,362.84 / $14,455.40
| Facility | | $6,370.80 | $9,362.84 | $14,455.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,938.64 / $9,938.64 / $9,938.64
| Facility | | $9,938.64 | $9,938.64 | $9,938.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,820.24 / $19,643.90 / $25,184.49
| Facility | | $13,820.24 | $19,643.90 | $25,184.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,170.11 / $13,862.74 / $17,533.86
| Facility | | $7,170.11 | $13,862.74 | $17,533.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,370.80 / $9,576.56 / $15,313.30
| Facility | | $6,370.80 | $9,576.56 | $15,313.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,450.58 / $12,740.59 / $19,356.65
| Facility | | $7,450.58 | $12,740.59 | $19,356.65 |