- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,892.68 / $15,012.30 / $26,417.30
| Facility | | $8,892.68 | $15,012.30 | $26,417.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,573.06 / $14,573.06 / $14,908.11
| Facility | | $14,573.06 | $14,573.06 | $14,908.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,964.28 / $8,948.45 / $14,598.98
| Facility | | $5,964.28 | $8,948.45 | $14,598.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,089.29 / $13,837.69 / $19,252.39
| Facility | | $8,089.29 | $13,837.69 | $19,252.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,304.65 / $28,304.65 / $33,217.91
| Facility | | $28,304.65 | $28,304.65 | $33,217.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $13,083.11 / $18,687.72
| Facility | | $1,787.00 | $13,083.11 | $18,687.72 |