- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $13,803.84 / $19,498.45
| Facility | | $5,754.40 | $13,803.84 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,892.96 / $20,892.96 / $20,892.96
| Facility | | $20,892.96 | $20,892.96 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $18,197.01 / $28,840.32
| Facility | | $11,748.98 | $18,197.01 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $13,803.84 / $28,840.32
| Facility | | $9,772.37 | $13,803.84 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $12,882.50 / $24,547.09
| Facility | | $8,511.38 | $12,882.50 | $24,547.09 |