- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,790.92 / $12,919.60 / $19,946.70
| Facility | | $8,790.92 | $12,919.60 | $19,946.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,102.54 / $16,102.54 / $16,102.54
| Facility | | $16,102.54 | $16,102.54 | $16,102.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,282.46 / $23,147.95 / $29,676.86
| Facility | | $16,282.46 | $23,147.95 | $29,676.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,893.87 / $19,128.87 / $24,194.56
| Facility | | $9,893.87 | $19,128.87 | $24,194.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,790.92 / $13,214.50 / $21,130.50
| Facility | | $8,790.92 | $13,214.50 | $21,130.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,280.87 / $17,580.43 / $26,709.79
| Facility | | $10,280.87 | $17,580.43 | $26,709.79 |