- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $11,748.98 / $16,982.44
| Facility | | $7,244.36 | $11,748.98 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $11,481.54 / $11,481.54
| Facility | | $11,481.54 | $11,481.54 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $13,803.84 / $18,620.87
| Facility | | $8,912.51 | $13,803.84 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $12,022.64 / $19,054.61
| Facility | | $7,413.10 | $12,022.64 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $8,511.38 / $18,620.87
| Facility | | $2,187.76 | $8,511.38 | $18,620.87 |