- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,311.88 / $11,140.10 / $17,833.70
| Facility | | $7,311.88 | $11,140.10 | $17,833.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,236.83 / $10,236.83 / $11,304.28
| Facility | | $10,236.83 | $10,236.83 | $11,304.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,574.72 / $8,899.36 / $12,629.20
| Facility | | $4,574.72 | $8,899.36 | $12,629.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,633.42 / $8,886.83 / $15,570.91
| Facility | | $6,633.42 | $8,886.83 | $15,570.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,513.48 / $10,064.42 / $13,486.62
| Facility | | $6,513.48 | $10,064.42 | $13,486.62 |