- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,458.80 / $7,960.75 / $12,922.80
| Facility | | $5,458.80 | $7,960.75 | $12,922.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,578.86 / $11,578.86 / $11,578.86
| Facility | | $11,578.86 | $11,578.86 | $11,578.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,474.89 / $17,734.91 / $22,737.07
| Facility | | $12,474.89 | $17,734.91 | $22,737.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,409.91 / $12,392.97 / $15,674.86
| Facility | | $6,409.91 | $12,392.97 | $15,674.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,695.35 / $8,561.21 / $13,689.80
| Facility | | $5,695.35 | $8,561.21 | $13,689.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,660.65 / $11,389.79 / $17,304.40
| Facility | | $6,660.65 | $11,389.79 | $17,304.40 |