- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,272.79 / $17,040.90 / $22,867.50
| Facility | | $10,272.79 | $17,040.90 | $22,867.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,890.78 / $11,890.78 / $11,890.78
| Facility | | $11,890.78 | $11,890.78 | $11,890.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,833.32 / $13,727.63 / $21,959.44
| Facility | | $7,833.32 | $13,727.63 | $21,959.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,435.36 / $13,720.50 / $31,466.59
| Facility | | $8,435.36 | $13,720.50 | $31,466.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,955.59 / $13,515.61 / $19,382.49
| Facility | | $9,955.59 | $13,515.61 | $19,382.49 |