- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,306.45 / $9,417.03 / $19,137.90
| Facility | | $7,306.45 | $9,417.03 | $19,137.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,777.06 / $9,777.06 / $9,777.06
| Facility | | $9,777.06 | $9,777.06 | $9,777.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,619.72 / $9,551.48 / $10,919.81
| Facility | | $7,619.72 | $9,551.48 | $10,919.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,832.11 / $10,323.45 / $13,426.09
| Facility | | $5,832.11 | $10,323.45 | $13,426.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,286.00 / $8,279.15 / $12,750.10
| Facility | | $1,286.00 | $8,279.15 | $12,750.10 |