- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $14,125.38 / $38,018.94
| Facility | | $8,912.51 | $14,125.38 | $38,018.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $16,218.10 / $25,118.86
| Facility | | $11,220.18 | $16,218.10 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $18,620.87 / $25,118.86
| Facility | | $12,022.64 | $18,620.87 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54,954.09 / $54,954.09 / $54,954.09
| Facility | | $54,954.09 | $54,954.09 | $54,954.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $19,498.45 / $29,512.09
| Facility | | $2,951.21 | $19,498.45 | $29,512.09 |