- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,096.90 / $20,326.90 / $28,780.70
| Facility | | $11,096.90 | $20,326.90 | $28,780.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,258.73 / $21,258.73 / $21,258.73
| Facility | | $21,258.73 | $21,258.73 | $21,258.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,989.90 / $19,376.48 / $30,633.77
| Facility | | $11,989.90 | $19,376.48 | $30,633.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,537.46 / $18,285.13 / $32,532.14
| Facility | | $11,537.46 | $18,285.13 | $32,532.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,117.00 / $17,492.02 / $38,469.32
| Facility | | $7,117.00 | $17,492.02 | $38,469.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $16,876.16 / $34,185.83
| Facility | | $3,308.00 | $16,876.16 | $34,185.83 |