- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,311.09 / $9,933.06 / $16,491.20
| Facility | | $7,311.09 | $9,933.06 | $16,491.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,819.94 / $8,909.40 / $14,769.52
| Facility | | $5,819.94 | $8,909.40 | $14,769.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,561.99 / $10,594.76 / $15,233.97
| Facility | | $8,561.99 | $10,594.76 | $15,233.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,322.50 / $10,636.48 / $26,024.48
| Facility | | $5,322.50 | $10,636.48 | $26,024.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,322.50 / $10,155.33 / $14,272.82
| Facility | | $5,322.50 | $10,155.33 | $14,272.82 |