- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $16,595.87 / $19,054.61
| Facility | | $12,022.64 | $16,595.87 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $8,709.64 / $8,709.64
| Facility | | $8,709.64 | $8,709.64 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $15,488.17 / $20,417.38
| Facility | | $8,709.64 | $15,488.17 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $12,022.64 / $29,512.09
| Facility | | $7,943.28 | $12,022.64 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $11,748.98 / $17,378.01
| Facility | | $7,943.28 | $11,748.98 | $17,378.01 |