- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $16,218.10 / $21,877.62
| Facility | | $10,232.93 | $16,218.10 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $10,471.29 / $10,471.29
| Facility | | $10,471.29 | $10,471.29 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $23,442.29 / $28,840.32
| Facility | | $15,848.93 | $23,442.29 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,498.45 / $19,498.45 / $19,498.45
| Facility | | $19,498.45 | $19,498.45 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $14,791.08 / $20,417.38
| Facility | | $10,471.29 | $14,791.08 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,498.45 / $19,498.45 / $19,498.45
| Facility | | $19,498.45 | $19,498.45 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $14,454.40 / $22,387.21
| Facility | | $9,120.11 | $14,454.40 | $22,387.21 |