- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,881.62 / $10,113.60 / $15,614.50
| Facility | | $6,881.62 | $10,113.60 | $15,614.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,330.18 / $16,107.54 / $20,650.68
| Facility | | $11,330.18 | $16,107.54 | $20,650.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,745.02 / $14,974.27 / $18,939.74
| Facility | | $7,745.02 | $14,974.27 | $18,939.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,881.62 / $10,344.40 / $16,541.20
| Facility | | $6,881.62 | $10,344.40 | $16,541.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,047.98 / $13,762.14 / $20,908.68
| Facility | | $8,047.98 | $13,762.14 | $20,908.68 |