- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,449.40 / $10,412.50 / $16,902.80
| Facility | | $7,449.40 | $10,412.50 | $16,902.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,466.66 / $16,466.66 / $24,229.44
| Facility | | $16,466.66 | $16,466.66 | $24,229.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,076.65 / $25,698.66 / $32,947.00
| Facility | | $18,076.65 | $25,698.66 | $32,947.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,384.04 / $16,209.75 / $20,502.40
| Facility | | $8,384.04 | $16,209.75 | $20,502.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,449.40 / $11,197.90 / $17,905.90
| Facility | | $7,449.40 | $11,197.90 | $17,905.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,804.41 / $14,897.61 / $22,633.80
| Facility | | $9,804.41 | $14,897.61 | $22,633.80 |