- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,664.30 / $19,392.50 / $25,382.10
| Facility | | $11,664.30 | $19,392.50 | $25,382.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,785.48 / $13,785.48 / $13,785.48
| Facility | | $13,785.48 | $13,785.48 | $13,785.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,866.01 / $17,411.25 / $26,378.41
| Facility | | $10,866.01 | $17,411.25 | $26,378.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,516.00 / $15,346.38 / $26,272.18
| Facility | | $7,516.00 | $15,346.38 | $26,272.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,003.76 / $14,624.73 / $23,322.10
| Facility | | $2,003.76 | $14,624.73 | $23,322.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,264.00 / $20,066.25 / $28,539.48
| Facility | | $7,264.00 | $20,066.25 | $28,539.48 |