- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $6,760.83 / $9,332.54
| Facility | | $2,818.38 | $6,760.83 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $12,022.64 / $12,022.64
| Facility | | $12,022.64 | $12,022.64 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $8,912.51 / $14,125.38
| Facility | | $5,623.41 | $8,912.51 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $6,606.93 / $13,803.84
| Facility | | $4,786.30 | $6,606.93 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $6,456.54 / $12,022.64
| Facility | | $4,168.69 | $6,456.54 | $12,022.64 |