- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,924.60 / $14,080.30 / $28,614.90
| Facility | | $10,924.60 | $14,080.30 | $28,614.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,095.02 / $15,095.02 / $15,095.02
| Facility | | $15,095.02 | $15,095.02 | $15,095.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,334.76 / $12,954.84 / $14,810.73
| Facility | | $10,334.76 | $12,954.84 | $14,810.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,720.14 / $15,435.56 / $20,074.62
| Facility | | $8,720.14 | $15,435.56 | $20,074.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,359.27 / $17,359.27 / $17,359.27
| Facility | | $17,359.27 | $17,359.27 | $17,359.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.00 / $14,025.40 / $19,717.88
| Facility | | $1,518.00 | $14,025.40 | $19,717.88 |