- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $19,952.62 / $45,708.82
| Facility | | $13,803.84 | $19,952.62 | $45,708.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $9,549.93 / $9,549.93
| Facility | | $9,549.93 | $9,549.93 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $14,454.40 / $25,703.96
| Facility | | $9,549.93 | $14,454.40 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,488.17 / $20,892.96 / $28,183.83
| Facility | | $15,488.17 | $20,892.96 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,595.87 / $30,902.95 / $46,773.51
| Facility | | $16,595.87 | $30,902.95 | $46,773.51 |