- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,216.82 / $12,987.50 / $28,470.50
| Facility | | $8,216.82 | $12,987.50 | $28,470.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,175.70 / $16,792.95 / $27,275.93
| Facility | | $11,175.70 | $16,792.95 | $27,275.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,717.96 / $14,913.14 / $20,592.37
| Facility | | $8,717.96 | $14,913.14 | $20,592.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,587.25 / $29,587.25 / $34,723.15
| Facility | | $29,587.25 | $29,587.25 | $34,723.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,241.00 / $5,274.00 / $19,417.62
| Facility | | $1,241.00 | $5,274.00 | $19,417.62 |