- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,712.30 / $14,189.90 / $24,826.90
| Facility | | $10,712.30 | $14,189.90 | $24,826.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,006.72 / $7,006.72 / $7,006.72
| Facility | | $7,006.72 | $7,006.72 | $7,006.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,843.91 / $12,031.55 / $24,596.58
| Facility | | $5,843.91 | $12,031.55 | $24,596.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,165.06 / $14,412.00 / $22,166.10
| Facility | | $10,165.06 | $14,412.00 | $22,166.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $14,623.36 / $22,335.37
| Facility | | $3,496.00 | $14,623.36 | $22,335.37 |