- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $11,481.54 / $13,182.57
| Facility | | $8,912.51 | $11,481.54 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $11,748.98 / $11,748.98
| Facility | | $11,748.98 | $11,748.98 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $9,120.11 / $11,220.18
| Facility | | $7,762.47 | $9,120.11 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $13,182.57 / $16,595.87
| Facility | | $8,128.31 | $13,182.57 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,489.63 / $13,489.63 / $13,489.63
| Facility | | $13,489.63 | $13,489.63 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $12,882.50 / $16,982.44
| Facility | | $1,862.09 | $12,882.50 | $16,982.44 |