- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $12,022.64 / $16,982.44
| Facility | | $6,760.83 | $12,022.64 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $14,125.38 / $22,908.68
| Facility | | $8,709.64 | $14,125.38 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $11,748.98 / $17,782.79
| Facility | | $6,606.93 | $11,748.98 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $12,589.25 / $15,488.17
| Facility | | $12,589.25 | $12,589.25 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $12,589.25 / $15,848.93
| Facility | | $5,495.41 | $12,589.25 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $22,387.21 / $26,302.68
| Facility | | $15,848.93 | $22,387.21 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $11,748.98 / $16,595.87
| Facility | | $6,456.54 | $11,748.98 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $6,918.31 / $10,964.78
| Facility | | $5,370.32 | $6,918.31 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $8,709.64 / $15,135.61
| Facility | | $3,801.89 | $8,709.64 | $15,135.61 |