- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $14,454.40 / $19,054.61
| Facility | | $8,912.51 | $14,454.40 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $11,748.98 / $14,454.40
| Facility | | $11,748.98 | $11,748.98 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,489.63 / $19,498.45 / $23,988.33
| Facility | | $13,489.63 | $19,498.45 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,378.01 / $17,378.01 / $17,378.01
| Facility | | $17,378.01 | $17,378.01 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $13,489.63 / $17,782.79
| Facility | | $9,120.11 | $13,489.63 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,378.01 / $17,378.01 / $17,378.01
| Facility | | $17,378.01 | $17,378.01 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $12,589.25 / $19,952.62
| Facility | | $7,943.28 | $12,589.25 | $19,952.62 |