- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,637.80 / $11,153.50 / $14,659.50
| Facility | | $7,637.80 | $11,153.50 | $14,659.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,244.89 / $11,560.47 / $19,552.98
| Facility | | $4,244.89 | $11,560.47 | $19,552.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,029.00 / $11,203.02 / $18,751.33
| Facility | | $8,029.00 | $11,203.02 | $18,751.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,607.31 / $12,502.72 / $18,254.99
| Facility | | $9,607.31 | $12,502.72 | $18,254.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,607.31 / $11,622.95 / $18,254.99
| Facility | | $9,607.31 | $11,622.95 | $18,254.99 |