- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,455.10 / $13,849.20 / $24,230.90
| Facility | | $10,455.10 | $13,849.20 | $24,230.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,009.75 / $18,009.75 / $18,009.75
| Facility | | $18,009.75 | $18,009.75 | $18,009.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,843.91 / $12,018.29 / $23,435.80
| Facility | | $5,843.91 | $12,018.29 | $23,435.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,839.24 / $14,066.02 / $21,633.98
| Facility | | $9,839.24 | $14,066.02 | $21,633.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $14,272.30 / $21,799.18
| Facility | | $3,496.00 | $14,272.30 | $21,799.18 |