- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,841.10 / $17,983.50 / $24,132.50
| Facility | | $10,841.10 | $17,983.50 | $24,132.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,306.56 / $13,306.56 / $13,306.56
| Facility | | $13,306.56 | $13,306.56 | $13,306.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,613.67 / $15,086.24 / $24,138.57
| Facility | | $8,613.67 | $15,086.24 | $24,138.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,902.00 / $14,479.50 / $33,207.29
| Facility | | $8,902.00 | $14,479.50 | $33,207.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,569.07 / $14,263.27 / $20,205.66
| Facility | | $10,569.07 | $14,263.27 | $20,205.66 |