- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $9,120.11 / $11,748.98
| Facility | | $7,943.28 | $9,120.11 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,162.28 / $3,162.28
| Facility | | $3,162.28 | $3,162.28 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $9,549.93 / $15,848.93
| Facility | | $4,073.80 | $9,549.93 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $11,220.18 / $18,620.87
| Facility | | $8,511.38 | $11,220.18 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $10,471.29 / $16,982.44
| Facility | | $5,248.07 | $10,471.29 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $9,549.93 / $14,454.40
| Facility | | $6,606.93 | $9,549.93 | $14,454.40 |