- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,257.60 / $10,584.00 / $17,181.20
| Facility | | $7,257.60 | $10,584.00 | $17,181.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,005.86 / $15,005.86 / $15,005.86
| Facility | | $15,005.86 | $15,005.86 | $15,005.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,886.94 / $18,378.71 / $23,598.26
| Facility | | $12,886.94 | $18,378.71 | $23,598.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,522.12 / $16,476.74 / $20,840.09
| Facility | | $8,522.12 | $16,476.74 | $20,840.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,572.10 / $11,382.30 / $18,200.90
| Facility | | $7,572.10 | $11,382.30 | $18,200.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,855.48 / $15,142.98 / $23,006.59
| Facility | | $8,855.48 | $15,142.98 | $23,006.59 |