- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,068.60 / $16,843.70 / $34,230.80
| Facility | | $13,068.60 | $16,843.70 | $34,230.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,591.79 / $15,591.79 / $24,038.34
| Facility | | $15,591.79 | $15,591.79 | $24,038.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,282.68 / $16,650.12 / $19,035.39
| Facility | | $13,282.68 | $16,650.12 | $19,035.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,431.56 / $18,464.96 / $24,014.48
| Facility | | $10,431.56 | $18,464.96 | $24,014.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,012.21 / $30,012.21 / $30,012.21
| Facility | | $30,012.21 | $30,012.21 | $30,012.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.00 / $16,778.04 / $23,587.74
| Facility | | $1,518.00 | $16,778.04 | $23,587.74 |