- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,914.50 / $16,329.20 / $23,120.40
| Facility | | $8,914.50 | $16,329.20 | $23,120.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,739.80 / $15,739.80 / $15,739.80
| Facility | | $15,739.80 | $15,739.80 | $15,739.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,465.49 / $15,324.88 / $24,256.04
| Facility | | $9,465.49 | $15,324.88 | $24,256.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,268.37 / $14,688.98 / $26,134.02
| Facility | | $9,268.37 | $14,688.98 | $26,134.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,898.06 / $13,859.04 / $30,903.53
| Facility | | $5,898.06 | $13,859.04 | $30,903.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $13,557.11 / $27,462.49
| Facility | | $3,308.00 | $13,557.11 | $27,462.49 |