- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,522.20 / $11,288.80 / $19,751.20
| Facility | | $8,522.20 | $11,288.80 | $19,751.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,046.59 / $11,046.59 / $11,046.59
| Facility | | $11,046.59 | $11,046.59 | $11,046.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,786.47 / $9,769.54 / $18,934.03
| Facility | | $5,786.47 | $9,769.54 | $18,934.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.04 / $12,133.88 / $17,635.80
| Facility | | $8,128.04 | $12,133.88 | $17,635.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $11,553.19 / $17,769.04
| Facility | | $3,496.00 | $11,553.19 | $17,769.04 |