- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $16,982.44 / $19,952.62
| Facility | | $12,589.25 | $16,982.44 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $13,489.63 / $22,908.68
| Facility | | $9,332.54 | $13,489.63 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $14,791.08 / $26,915.35
| Facility | | $6,165.95 | $14,791.08 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151,356.12 / $151,356.12 / $151,356.12
| Facility | | $151,356.12 | $151,356.12 | $151,356.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $16,982.44 / $26,915.35
| Facility | | $12,882.50 | $16,982.44 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $16,982.44 / $25,703.96
| Facility | | $8,709.64 | $16,982.44 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $15,135.61 / $21,877.62
| Facility | | $9,772.37 | $15,135.61 | $21,877.62 |