- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,988.40 / $11,665.40 / $15,332.40
| Facility | | $7,988.40 | $11,665.40 | $15,332.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,763.65 / $8,763.65 / $8,763.65
| Facility | | $8,763.65 | $8,763.65 | $8,763.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,514.12 / $9,570.28 / $16,186.84
| Facility | | $3,514.12 | $9,570.28 | $16,186.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,348.32 / $11,160.00 / $19,612.08
| Facility | | $7,348.32 | $11,160.00 | $19,612.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,048.32 / $13,076.64 / $19,092.96
| Facility | | $10,048.32 | $13,076.64 | $19,092.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,048.32 / $12,156.48 / $19,092.96
| Facility | | $10,048.32 | $12,156.48 | $19,092.96 |