- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $12,882.50 / $16,595.87
| Facility | | $8,912.51 | $12,882.50 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $5,623.41 / $11,748.98
| Facility | | $3,019.95 | $5,623.41 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $6,309.57 / $11,748.98
| Facility | | $4,570.88 | $6,309.57 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $6,309.57 / $11,748.98
| Facility | | $4,570.88 | $6,309.57 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $8,128.31 / $12,589.25
| Facility | | $3,388.44 | $8,128.31 | $12,589.25 |