- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,911.90 / $17,103.59 / $29,924.80
| Facility | | $12,911.90 | $17,103.59 | $29,924.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,178.20 / $11,178.20 / $11,178.20
| Facility | | $11,178.20 | $11,178.20 | $11,178.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,939.30 / $14,552.76 / $29,750.77
| Facility | | $5,939.30 | $14,552.76 | $29,750.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,846.43 / $17,371.31 / $26,717.63
| Facility | | $11,846.43 | $17,371.31 | $26,717.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $18,920.40 / $30,276.74
| Facility | | $3,496.00 | $18,920.40 | $30,276.74 |