- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,460.36 / $11,833.80 / $16,755.40
| Facility | | $6,460.36 | $11,833.80 | $16,755.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,313.66 / $12,313.66 / $12,313.66
| Facility | | $12,313.66 | $12,313.66 | $12,313.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,124.50 / $9,778.78 / $15,448.36
| Facility | | $6,124.50 | $9,778.78 | $15,448.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,716.82 / $10,645.14 / $18,939.40
| Facility | | $6,716.82 | $10,645.14 | $18,939.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,986.72 / $9,881.86 / $22,395.87
| Facility | | $4,986.72 | $9,881.86 | $22,395.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $9,824.87 / $19,902.14
| Facility | | $3,308.00 | $9,824.87 | $19,902.14 |