- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $12,589.25 / $16,218.10
| Facility | | $8,912.51 | $12,589.25 | $16,218.10 |
- 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 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $11,481.54 / $15,135.61
| Facility | | $6,165.95 | $11,481.54 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $15,848.93 / $20,892.96
| Facility | | $10,232.93 | $15,848.93 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $13,803.84 / $22,387.21
| Facility | | $7,585.78 | $13,803.84 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35,481.34 / $35,481.34 / $35,481.34
| Facility | | $35,481.34 | $35,481.34 | $35,481.34 |