- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,195.70 / $13,835.70 / $24,346.90
| Facility | | $8,195.70 | $13,835.70 | $24,346.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,628.00 / $11,805.09 / $14,600.00
| Facility | | $2,628.00 | $11,805.09 | $14,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,020.44 / $8,958.95 / $14,616.10
| Facility | | $6,020.44 | $8,958.95 | $14,616.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,455.28 / $12,753.15 / $17,745.77
| Facility | | $7,455.28 | $12,753.15 | $17,745.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,126.35 / $26,126.35 / $30,661.49
| Facility | | $26,126.35 | $26,126.35 | $30,661.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $12,057.71 / $17,223.05
| Facility | | $1,787.00 | $12,057.71 | $17,223.05 |