- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $13,489.63 / $16,595.87
| Facility | | $5,128.61 | $13,489.63 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $6,760.83 / $6,760.83
| Facility | | $6,760.83 | $6,760.83 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $15,848.93 / $25,703.96
| Facility | | $10,471.29 | $15,848.93 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $12,302.69 / $25,703.96
| Facility | | $8,912.51 | $12,302.69 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $11,481.54 / $21,877.62
| Facility | | $7,585.78 | $11,481.54 | $21,877.62 |