- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $13,182.57 / $16,595.87
| Facility | | $8,128.31 | $13,182.57 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $15,488.17 / $19,054.61
| Facility | | $10,471.29 | $15,488.17 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $15,848.93 / $15,848.93
| Facility | | $15,848.93 | $15,848.93 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $12,589.25 / $16,595.87
| Facility | | $8,709.64 | $12,589.25 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $15,848.93 / $15,848.93
| Facility | | $15,848.93 | $15,848.93 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $8,128.31 / $13,489.63
| Facility | | $5,495.41 | $8,128.31 | $13,489.63 |