- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $13,182.57 / $22,908.68
| Facility | | $11,220.18 | $13,182.57 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $12,882.50 / $12,882.50
| Facility | | $12,882.50 | $12,882.50 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $13,489.63 / $21,877.62
| Facility | | $7,943.28 | $13,489.63 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $17,782.79 / $23,442.29
| Facility | | $11,220.18 | $17,782.79 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $17,378.01 / $26,915.35
| Facility | | $10,471.29 | $17,378.01 | $26,915.35 |