- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,080.69 / $10,406.10 / $16,066.10
| Facility | | $7,080.69 | $10,406.10 | $16,066.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,029.70 / $13,029.70 / $15,655.51
| Facility | | $13,029.70 | $13,029.70 | $15,655.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,647.40 / $20,823.47 / $26,696.75
| Facility | | $14,647.40 | $20,823.47 | $26,696.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,969.06 / $15,407.44 / $19,487.62
| Facility | | $7,969.06 | $15,407.44 | $19,487.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,080.69 / $10,643.70 / $17,019.70
| Facility | | $7,080.69 | $10,643.70 | $17,019.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,280.78 / $14,160.24 / $21,513.52
| Facility | | $8,280.78 | $14,160.24 | $21,513.52 |