- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,982.60 / $14,155.10 / $28,766.90
| Facility | | $10,982.60 | $14,155.10 | $28,766.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,231.05 / $15,231.05 / $15,231.05
| Facility | | $15,231.05 | $15,231.05 | $15,231.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,657.10 / $13,358.90 / $15,272.68
| Facility | | $10,657.10 | $13,358.90 | $15,272.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,766.46 / $14,438.62 / $19,847.16
| Facility | | $8,766.46 | $14,438.62 | $19,847.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,286.00 / $12,444.71 / $19,165.16
| Facility | | $1,286.00 | $12,444.71 | $19,165.16 |