- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,413.20 / $13,793.80 / $24,133.90
| Facility | | $10,413.20 | $13,793.80 | $24,133.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,491.00 / $16,491.00 / $16,802.46
| Facility | | $16,491.00 | $16,491.00 | $16,802.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,843.91 / $12,377.28 / $23,946.87
| Facility | | $5,843.91 | $12,377.28 | $23,946.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,988.39 / $14,132.45 / $21,549.09
| Facility | | $9,988.39 | $14,132.45 | $21,549.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $14,215.16 / $24,417.72
| Facility | | $3,496.00 | $14,215.16 | $24,417.72 |