- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,258.18 / $12,716.10 / $22,342.10
| Facility | | $6,258.18 | $12,716.10 | $22,342.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,051.60 / $22,335.54 / $28,962.32
| Facility | | $15,051.60 | $22,335.54 | $28,962.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,180.60 / $17,929.84 / $28,667.93
| Facility | | $14,180.60 | $17,929.84 | $28,667.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,052.26 / $19,315.65 / $40,505.54
| Facility | | $10,052.26 | $19,315.65 | $40,505.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,180.60 / $19,188.09 / $28,675.00
| Facility | | $14,180.60 | $19,188.09 | $28,675.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,870.00 / $15,806.00 / $24,662.28
| Facility | | $4,870.00 | $15,806.00 | $24,662.28 |