- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $15,848.93 / $25,118.86
| Facility | | $6,456.54 | $15,848.93 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,302.69 / $25,118.86 / $30,902.95
| Facility | | $12,302.69 | $25,118.86 | $30,902.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,489.63 / $20,892.96 / $26,915.35
| Facility | | $13,489.63 | $20,892.96 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $14,454.40 / $23,988.33
| Facility | | $8,128.31 | $14,454.40 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $14,125.38 / $25,118.86
| Facility | | $4,365.16 | $14,125.38 | $25,118.86 |