- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,822.60 / $12,923.40 / $17,853.20
| Facility | | $8,822.60 | $12,923.40 | $17,853.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,617.36 / $11,824.91 / $17,617.43
| Facility | | $7,617.36 | $11,824.91 | $17,617.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,160.88 / $11,266.58 / $20,392.00
| Facility | | $8,160.88 | $11,266.58 | $20,392.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $86.75 / $120.00 / $190.43
| Facility | | $86.75 | $120.00 | $190.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,988.79 / $12,440.14 / $20,473.57
| Facility | | $8,988.79 | $12,440.14 | $20,473.57 |