- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $11,481.54 / $15,135.61
| Facility | | $7,079.46 | $11,481.54 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $15,488.17 / $19,498.45
| Facility | | $10,715.19 | $15,488.17 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $13,803.84 / $13,803.84
| Facility | | $13,803.84 | $13,803.84 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $11,220.18 / $15,135.61
| Facility | | $7,585.78 | $11,220.18 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $13,803.84 / $13,803.84
| Facility | | $13,803.84 | $13,803.84 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $10,232.93 / $15,848.93
| Facility | | $6,456.54 | $10,232.93 | $15,848.93 |