- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $13,182.57 / $19,498.45
| Facility | | $9,549.93 | $13,182.57 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $18,620.87 / $22,908.68
| Facility | | $12,589.25 | $18,620.87 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,197.01 / $18,197.01 / $18,197.01
| Facility | | $18,197.01 | $18,197.01 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $15,488.17 / $21,877.62
| Facility | | $10,715.19 | $15,488.17 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,197.01 / $18,197.01 / $18,197.01
| Facility | | $18,197.01 | $18,197.01 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $9,120.11 / $15,848.93
| Facility | | $5,754.40 | $9,120.11 | $15,848.93 |