- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,387.40 / $12,231.60 / $19,855.80
| Facility | | $8,387.40 | $12,231.60 | $19,855.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,741.40 / $15,741.40 / $15,741.40
| Facility | | $15,741.40 | $15,741.40 | $15,741.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,890.72 / $31,120.93 / $39,898.62
| Facility | | $21,890.72 | $31,120.93 | $39,898.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,848.78 / $19,041.68 / $24,084.29
| Facility | | $9,848.78 | $19,041.68 | $24,084.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,750.85 / $13,154.20 / $21,034.20
| Facility | | $8,750.85 | $13,154.20 | $21,034.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,234.03 / $17,500.31 / $26,588.06
| Facility | | $10,234.03 | $17,500.31 | $26,588.06 |