- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,002.29 / $12,891.60 / $26,199.20
| Facility | | $10,002.29 | $12,891.60 | $26,199.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,117.25 / $14,117.25 / $14,117.25
| Facility | | $14,117.25 | $14,117.25 | $14,117.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,630.44 / $12,071.96 / $13,801.37
| Facility | | $9,630.44 | $12,071.96 | $13,801.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,983.98 / $14,132.48 / $18,379.89
| Facility | | $7,983.98 | $14,132.48 | $18,379.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,234.84 / $16,234.84 / $16,234.84
| Facility | | $16,234.84 | $16,234.84 | $16,234.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,286.00 / $11,333.90 / $17,454.48
| Facility | | $1,286.00 | $11,333.90 | $17,454.48 |