- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,773.40 / $13,885.40 / $28,218.80
| Facility | | $10,773.40 | $13,885.40 | $28,218.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,200.58 / $17,200.58 / $17,200.58
| Facility | | $17,200.58 | $17,200.58 | $17,200.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,299.96 / $12,911.23 / $14,760.87
| Facility | | $10,299.96 | $12,911.23 | $14,760.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,599.45 / $15,221.93 / $19,796.77
| Facility | | $8,599.45 | $15,221.93 | $19,796.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,780.66 / $19,780.66 / $19,780.66
| Facility | | $19,780.66 | $19,780.66 | $19,780.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.00 / $13,831.28 / $19,444.98
| Facility | | $1,518.00 | $13,831.28 | $19,444.98 |