- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $13,489.63 / $15,848.93
| Facility | | $8,709.64 | $13,489.63 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $14,454.40 / $19,498.45
| Facility | | $9,772.37 | $14,454.40 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $13,803.84 / $17,378.01
| Facility | | $8,709.64 | $13,803.84 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $15,488.17 / $20,892.96
| Facility | | $9,772.37 | $15,488.17 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $14,125.38 / $20,892.96
| Facility | | $4,073.80 | $14,125.38 | $20,892.96 |