- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $13,182.57 / $16,982.44
| Facility | | $11,748.98 | $13,182.57 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,302.69 / $12,302.69 / $13,489.63
| Facility | | $12,302.69 | $12,302.69 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $13,489.63 / $23,988.33
| Facility | | $5,754.40 | $13,489.63 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151,356.12 / $151,356.12 / $151,356.12
| Facility | | $151,356.12 | $151,356.12 | $151,356.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $15,848.93 / $23,442.29
| Facility | | $12,022.64 | $15,848.93 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $14,454.40 / $23,988.33
| Facility | | $7,585.78 | $14,454.40 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $13,489.63 / $20,417.38
| Facility | | $9,120.11 | $13,489.63 | $20,417.38 |