- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $15,135.61 / $19,952.62
| Facility | | $5,888.44 | $15,135.61 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $12,589.25 / $12,589.25
| Facility | | $12,589.25 | $12,589.25 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $17,378.01 / $19,498.45
| Facility | | $12,589.25 | $17,378.01 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $15,848.93 / $21,877.62
| Facility | | $12,882.50 | $15,848.93 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $18,620.87 / $26,302.68
| Facility | | $2,041.74 | $18,620.87 | $26,302.68 |