- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $10,232.93 / $14,454.40
| Facility | | $4,265.80 | $10,232.93 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $10,232.93 / $10,715.19
| Facility | | $8,709.64 | $10,232.93 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $10,964.78 / $10,964.78
| Facility | | $10,964.78 | $10,964.78 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $10,232.93 / $21,379.62
| Facility | | $7,244.36 | $10,232.93 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $9,772.37 / $18,197.01
| Facility | | $6,309.57 | $9,772.37 | $18,197.01 |