- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,154.14 / $6,105.12 / $9,425.77
| Facility | | $4,154.14 | $6,105.12 | $9,425.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,218.35 / $8,218.35 / $8,218.35
| Facility | | $8,218.35 | $8,218.35 | $8,218.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,620.21 / $12,254.93 / $15,711.45
| Facility | | $8,620.21 | $12,254.93 | $15,711.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.13 / $8,708.42 / $11,433.10
| Facility | | $13.13 | $8,708.42 | $11,433.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,154.14 / $6,244.48 / $9,985.19
| Facility | | $4,154.14 | $6,244.48 | $9,985.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,858.22 / $8,307.61 / $12,621.67
| Facility | | $4,858.22 | $8,307.61 | $12,621.67 |