- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $10,715.19 / $14,454.40
| Facility | | $4,265.80 | $10,715.19 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $11,748.98 / $11,748.98
| Facility | | $11,748.98 | $11,748.98 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $11,748.98 / $13,182.57
| Facility | | $8,511.38 | $11,748.98 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $11,481.54 / $15,848.93
| Facility | | $9,120.11 | $11,481.54 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $13,182.57 / $19,498.45
| Facility | | $2,041.74 | $13,182.57 | $19,498.45 |