- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,031.15 / $13,322.30 / $17,877.50
| Facility | | $8,031.15 | $13,322.30 | $17,877.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,659.48 / $9,659.48 / $9,659.48
| Facility | | $9,659.48 | $9,659.48 | $9,659.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,296.35 / $10,757.76 / $16,915.98
| Facility | | $6,296.35 | $10,757.76 | $16,915.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,594.65 / $10,726.50 / $24,600.16
| Facility | | $6,594.65 | $10,726.50 | $24,600.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,783.15 / $10,566.32 / $14,968.47
| Facility | | $7,783.15 | $10,566.32 | $14,968.47 |