- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,976.50 / $17,189.20 / $30,074.50
| Facility | | $12,976.50 | $17,189.20 | $30,074.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,353.93 / $7,353.93 / $7,353.93
| Facility | | $7,353.93 | $7,353.93 | $7,353.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,939.30 / $13,529.36 / $29,321.25
| Facility | | $5,939.30 | $13,529.36 | $29,321.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,905.69 / $17,458.21 / $26,851.28
| Facility | | $11,905.69 | $17,458.21 | $26,851.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $17,714.25 / $30,428.19
| Facility | | $3,496.00 | $17,714.25 | $30,428.19 |