- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,028.79 / $12,925.80 / $26,268.60
| Facility | | $10,028.79 | $12,925.80 | $26,268.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,867.06 / $12,867.06 / $12,867.06
| Facility | | $12,867.06 | $12,867.06 | $12,867.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,018.10 / $12,557.90 / $14,356.93
| Facility | | $10,018.10 | $12,557.90 | $14,356.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,005.14 / $14,169.94 / $18,428.62
| Facility | | $8,005.14 | $14,169.94 | $18,428.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.00 / $12,875.40 / $18,101.13
| Facility | | $1,518.00 | $12,875.40 | $18,101.13 |