- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $9,549.93 / $12,589.25
| Facility | | $5,888.44 | $9,549.93 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $13,182.57 / $16,595.87
| Facility | | $9,120.11 | $13,182.57 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $11,481.54 / $11,481.54
| Facility | | $11,481.54 | $11,481.54 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $9,120.11 / $12,022.64
| Facility | | $6,025.60 | $9,120.11 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $11,481.54 / $11,481.54
| Facility | | $11,481.54 | $11,481.54 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $8,317.64 / $13,182.57
| Facility | | $5,248.07 | $8,317.64 | $13,182.57 |