- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,824.62 / $14,346.90 / $18,856.70
| Facility | | $9,824.62 | $14,346.90 | $18,856.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,123.13 / $12,123.13 / $12,123.13
| Facility | | $12,123.13 | $12,123.13 | $12,123.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,954.09 / $10,768.48 / $18,213.43
| Facility | | $3,954.09 | $10,768.48 | $18,213.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,980.46 / $14,410.63 / $24,120.13
| Facility | | $9,980.46 | $14,410.63 | $24,120.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,358.04 / $16,082.45 / $23,481.69
| Facility | | $12,358.04 | $16,082.45 | $23,481.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,358.04 / $14,950.78 / $23,481.69
| Facility | | $12,358.04 | $14,950.78 | $23,481.69 |