- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,311.43 / $12,960.70 / $16,514.70
| Facility | | $8,311.43 | $12,960.70 | $16,514.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32,838.39 / $32,838.39 / $32,838.39
| Facility | | $32,838.39 | $32,838.39 | $32,838.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,431.23 / $13,276.54 / $15,638.04
| Facility | | $7,431.23 | $13,276.54 | $15,638.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,074.24 / $13,464.51 / $18,862.79
| Facility | | $7,074.24 | $13,464.51 | $18,862.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,794.76 / $14,687.91 / $18,862.79
| Facility | | $12,794.76 | $14,687.91 | $18,862.79 |