- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $12,589.25 / $16,218.10
| Facility | | $8,709.64 | $12,589.25 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $7,413.10 / $19,952.62
| Facility | | $7,413.10 | $7,413.10 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $10,964.78 / $15,135.61
| Facility | | $6,165.95 | $10,964.78 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $14,454.40 / $18,620.87
| Facility | | $9,332.54 | $14,454.40 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $12,882.50 / $19,952.62
| Facility | | $7,585.78 | $12,882.50 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32,359.37 / $32,359.37 / $32,359.37
| Facility | | $32,359.37 | $32,359.37 | $32,359.37 |