- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $8,912.51 / $10,964.78
| Facility | | $3,548.13 | $8,912.51 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $12,589.25 / $12,589.25
| Facility | | $12,589.25 | $12,589.25 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $7,762.47 / $8,912.51
| Facility | | $5,754.40 | $7,762.47 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $10,471.29 / $14,454.40
| Facility | | $8,317.64 | $10,471.29 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $5,495.41 / $13,489.63
| Facility | | $1,862.09 | $5,495.41 | $13,489.63 |