- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,090.75 / $15,346.70 / $27,005.70
| Facility | | $9,090.75 | $15,346.70 | $27,005.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,950.91 / $11,736.33 / $19,405.37
| Facility | | $7,950.91 | $11,736.33 | $19,405.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,269.45 / $14,145.89 / $19,597.86
| Facility | | $8,269.45 | $14,145.89 | $19,597.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,417.65 / $29,417.65 / $34,524.11
| Facility | | $29,417.65 | $29,417.65 | $34,524.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $13,374.50 / $19,103.93
| Facility | | $1,787.00 | $13,374.50 | $19,103.93 |