- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $17,782.79 / $25,703.96
| Facility | | $10,964.78 | $17,782.79 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,547.09 / $24,547.09 / $24,547.09
| Facility | | $24,547.09 | $24,547.09 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,489.63 / $20,892.96 / $28,183.83
| Facility | | $13,489.63 | $20,892.96 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $17,782.79 / $28,840.32
| Facility | | $11,220.18 | $17,782.79 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $15,135.61 / $28,183.83
| Facility | | $4,073.80 | $15,135.61 | $28,183.83 |