- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,670.40 / $14,121.70 / $18,560.70
| Facility | | $9,670.40 | $14,121.70 | $18,560.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,409.90 / $10,409.90 / $10,409.90
| Facility | | $10,409.90 | $10,409.90 | $10,409.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,487.87 / $12,222.16 / $20,672.14
| Facility | | $4,487.87 | $12,222.16 | $20,672.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,823.79 / $14,184.42 / $23,741.51
| Facility | | $9,823.79 | $14,184.42 | $23,741.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,164.05 / $15,830.00 / $23,113.09
| Facility | | $12,164.05 | $15,830.00 | $23,113.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,164.05 / $14,716.09 / $23,113.09
| Facility | | $12,164.05 | $14,716.09 | $23,113.09 |