- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $10,471.29 / $28,183.83
| Facility | | $6,760.83 | $10,471.29 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $19,952.62 / $30,902.95
| Facility | | $13,803.84 | $19,952.62 | $30,902.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $14,125.38 / $19,054.61
| Facility | | $8,912.51 | $14,125.38 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40,738.03 / $40,738.03 / $40,738.03
| Facility | | $40,738.03 | $40,738.03 | $40,738.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $14,454.40 / $22,387.21
| Facility | | $2,951.21 | $14,454.40 | $22,387.21 |