- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,578.43 / $11,363.30 / $19,881.50
| Facility | | $8,578.43 | $11,363.30 | $19,881.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,158.80 / $11,158.80 / $11,158.80
| Facility | | $11,158.80 | $11,158.80 | $11,158.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,843.91 / $11,082.47 / $19,958.89
| Facility | | $5,843.91 | $11,082.47 | $19,958.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,228.44 / $12,213.92 / $17,752.13
| Facility | | $8,228.44 | $12,213.92 | $17,752.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $11,710.44 / $17,886.25
| Facility | | $3,496.00 | $11,710.44 | $17,886.25 |