- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $13,489.63 / $25,118.86
| Facility | | $8,709.64 | $13,489.63 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,489.63 / $15,848.93 / $16,595.87
| Facility | | $13,489.63 | $15,848.93 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $11,481.54 / $18,197.01
| Facility | | $7,413.10 | $11,481.54 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $10,964.78 / $21,379.62
| Facility | | $6,025.60 | $10,964.78 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $12,022.64 / $16,982.44
| Facility | | $6,025.60 | $12,022.64 | $16,982.44 |