- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,416.91 / $10,463.20 / $10,463.20
| Facility | | $9,416.91 | $10,463.20 | $10,463.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,478.04 / $8,478.04 / $8,478.04
| Facility | | $8,478.04 | $8,478.04 | $8,478.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,807.21 / $9,159.95 / $18,961.96
| Facility | | $5,807.21 | $9,159.95 | $18,961.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,649.12 / $12,261.13 / $18,552.27
| Facility | | $8,649.12 | $12,261.13 | $18,552.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $15,631.81 / $20,183.29
| Facility | | $6,965.00 | $15,631.81 | $20,183.29 |