- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,308.95 / $10,370.20 / $15,808.70
| Facility | | $5,308.95 | $10,370.20 | $15,808.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,395.77 / $11,395.77 / $11,857.65
| Facility | | $11,395.77 | $11,395.77 | $11,857.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,851.75 / $9,381.03 / $14,755.13
| Facility | | $5,851.75 | $9,381.03 | $14,755.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,337.32 / $6,337.32 / $6,337.32
| Facility | | $6,337.32 | $6,337.32 | $6,337.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,032.84 / $9,743.15 / $21,130.51
| Facility | | $4,032.84 | $9,743.15 | $21,130.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $9,269.77 / $18,777.66
| Facility | | $3,308.00 | $9,269.77 | $18,777.66 |