- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,162.59 / $11,919.80 / $15,666.70
| Facility | | $8,162.59 | $11,919.80 | $15,666.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,888.66 / $9,888.66 / $12,160.89
| Facility | | $9,888.66 | $9,888.66 | $12,160.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,668.92 / $12,715.24 / $21,506.11
| Facility | | $4,668.92 | $12,715.24 | $21,506.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,292.07 / $11,972.78 / $20,039.73
| Facility | | $8,292.07 | $11,972.78 | $20,039.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,267.43 / $13,361.78 / $19,509.29
| Facility | | $10,267.43 | $13,361.78 | $19,509.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,267.43 / $12,421.56 / $19,509.29
| Facility | | $10,267.43 | $12,421.56 | $19,509.29 |