- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,182.57 / $20,417.38 / $38,018.94
| Facility | | $13,182.57 | $20,417.38 | $38,018.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,197.01 / $18,197.01 / $18,197.01
| Facility | | $18,197.01 | $18,197.01 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $17,378.01 / $27,542.29
| Facility | | $11,220.18 | $17,378.01 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $13,803.84 / $27,542.29
| Facility | | $6,165.95 | $13,803.84 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $18,197.01 / $25,703.96
| Facility | | $6,309.57 | $18,197.01 | $25,703.96 |