- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,582.70 / $13,639.70 / $27,719.50
| Facility | | $10,582.70 | $13,639.70 | $27,719.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,319.85 / $12,936.15 / $14,789.36
| Facility | | $10,319.85 | $12,936.15 | $14,789.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,447.29 / $14,952.60 / $19,446.50
| Facility | | $8,447.29 | $14,952.60 | $19,446.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,458.32 / $12,458.32 / $12,458.32
| Facility | | $12,458.32 | $12,458.32 | $12,458.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,286.00 / $11,991.62 / $18,467.38
| Facility | | $1,286.00 | $11,991.62 | $18,467.38 |