- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,418.09 / $12,475.60 / $21,827.50
| Facility | | $9,418.09 | $12,475.60 | $21,827.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,650.07 / $7,650.07 / $7,650.07
| Facility | | $7,650.07 | $7,650.07 | $7,650.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,843.91 / $12,178.60 / $23,783.76
| Facility | | $5,843.91 | $12,178.60 | $23,783.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,033.84 / $12,781.86 / $19,488.15
| Facility | | $9,033.84 | $12,781.86 | $19,488.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $12,856.67 / $19,636.97
| Facility | | $3,496.00 | $12,856.67 | $19,636.97 |