- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,768.37 / $12,804.40 / $16,829.40
| Facility | | $8,768.37 | $12,804.40 | $16,829.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,040.40 / $11,003.52 / $18,610.98
| Facility | | $4,040.40 | $11,003.52 | $18,610.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,907.46 / $12,861.34 / $23,046.73
| Facility | | $8,907.46 | $12,861.34 | $23,046.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,029.43 / $14,353.43 / $20,957.18
| Facility | | $11,029.43 | $14,353.43 | $20,957.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,029.43 / $13,343.43 / $20,957.18
| Facility | | $11,029.43 | $13,343.43 | $20,957.18 |