- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,918.09 / $13,685.40 / $22,904.50
| Facility | | $9,918.09 | $13,685.40 | $22,904.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,083.67 / $14,083.67 / $14,083.67
| Facility | | $14,083.67 | $14,083.67 | $14,083.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,272.00 / $14,965.07 / $22,996.51
| Facility | | $3,272.00 | $14,965.07 | $22,996.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,151.09 / $15,396.65 / $25,820.09
| Facility | | $10,151.09 | $15,396.65 | $25,820.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,062.00 / $15,700.49 / $27,630.54
| Facility | | $4,062.00 | $15,700.49 | $27,630.54 |