- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,525.39 / $10,988.10 / $22,330.70
| Facility | | $8,525.39 | $10,988.10 | $22,330.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,626.62 / $8,626.62 / $8,626.62
| Facility | | $8,626.62 | $8,626.62 | $8,626.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,616.88 / $9,547.92 / $10,915.74
| Facility | | $7,616.88 | $9,547.92 | $10,915.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,805.08 / $12,045.71 / $15,665.97
| Facility | | $6,805.08 | $12,045.71 | $15,665.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,286.00 / $9,660.36 / $14,877.20
| Facility | | $1,286.00 | $9,660.36 | $14,877.20 |