- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,217.50 / $12,076.80 / $18,645.59
| Facility | | $8,217.50 | $12,076.80 | $18,645.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,819.51 / $21,068.14 / $27,010.44
| Facility | | $14,819.51 | $21,068.14 | $27,010.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,248.51 / $17,881.13 / $22,616.39
| Facility | | $9,248.51 | $17,881.13 | $22,616.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,217.50 / $12,352.50 / $19,752.20
| Facility | | $8,217.50 | $12,352.50 | $19,752.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,610.28 / $16,433.68 / $24,967.55
| Facility | | $9,610.28 | $16,433.68 | $24,967.55 |