- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $12,302.69 / $15,848.93
| Facility | | $8,317.64 | $12,302.69 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $5,248.07 / $11,220.18
| Facility | | $2,691.53 | $5,248.07 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $6,025.60 / $11,220.18
| Facility | | $4,365.16 | $6,025.60 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $6,025.60 / $11,220.18
| Facility | | $4,365.16 | $6,025.60 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $7,762.47 / $12,302.69
| Facility | | $3,235.94 | $7,762.47 | $12,302.69 |