- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,705.30 / $13,797.70 / $28,040.50
| Facility | | $10,705.30 | $13,797.70 | $28,040.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,871.48 / $11,871.48 / $11,871.48
| Facility | | $11,871.48 | $11,871.48 | $11,871.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,163.65 / $12,740.35 / $14,565.51
| Facility | | $10,163.65 | $12,740.35 | $14,565.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,545.11 / $15,125.74 / $19,671.68
| Facility | | $8,545.11 | $15,125.74 | $19,671.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.00 / $13,123.91 / $19,322.09
| Facility | | $1,518.00 | $13,123.91 | $19,322.09 |