- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $19,952.62 / $38,018.94
| Facility | | $12,882.50 | $19,952.62 | $38,018.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,498.45 / $19,498.45 / $19,498.45
| Facility | | $19,498.45 | $19,498.45 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $16,982.44 / $27,542.29
| Facility | | $11,220.18 | $16,982.44 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $19,952.62 / $38,904.51
| Facility | | $9,549.93 | $19,952.62 | $38,904.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $17,782.79 / $25,118.86
| Facility | | $6,309.57 | $17,782.79 | $25,118.86 |