- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,224.46 / $15,065.20 / $21,330.80
| Facility | | $8,224.46 | $15,065.20 | $21,330.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,438.69 / $9,438.69 / $9,438.69
| Facility | | $9,438.69 | $9,438.69 | $9,438.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,513.12 / $13,495.33 / $21,246.80
| Facility | | $8,513.12 | $13,495.33 | $21,246.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,550.95 / $13,551.98 / $24,111.12
| Facility | | $8,550.95 | $13,551.98 | $24,111.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,441.52 / $13,080.06 / $28,511.44
| Facility | | $5,441.52 | $13,080.06 | $28,511.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $12,507.72 / $25,336.75
| Facility | | $3,308.00 | $12,507.72 | $25,336.75 |