- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,265.91 / $13,954.20 / $24,555.40
| Facility | | $8,265.91 | $13,954.20 | $24,555.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,759.64 / $13,759.64 / $13,759.64
| Facility | | $13,759.64 | $13,759.64 | $13,759.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,290.71 / $10,357.86 / $17,175.90
| Facility | | $7,290.71 | $10,357.86 | $17,175.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,519.14 / $12,862.38 / $17,897.75
| Facility | | $7,519.14 | $12,862.38 | $17,897.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,606.00 / $26,606.00 / $31,224.40
| Facility | | $26,606.00 | $26,606.00 | $31,224.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $12,160.98 / $17,370.57
| Facility | | $1,787.00 | $12,160.98 | $17,370.57 |