- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,088.60 / $17,031.20 / $29,969.90
| Facility | | $10,088.60 | $17,031.20 | $29,969.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,692.57 / $25,692.57 / $25,692.57
| Facility | | $25,692.57 | $25,692.57 | $25,692.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,306.48 / $10,785.08 / $17,832.53
| Facility | | $7,306.48 | $10,785.08 | $17,832.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,177.12 / $15,698.59 / $21,676.93
| Facility | | $9,177.12 | $15,698.59 | $21,676.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,935.15 / $31,935.15 / $37,478.61
| Facility | | $31,935.15 | $31,935.15 | $37,478.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $14,842.52 / $21,200.85
| Facility | | $1,787.00 | $14,842.52 | $21,200.85 |