- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,655.10 / $13,733.00 / $27,909.10
| Facility | | $10,655.10 | $13,733.00 | $27,909.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,734.67 / $15,734.67 / $15,734.67
| Facility | | $15,734.67 | $15,734.67 | $15,734.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,053.28 / $13,855.52 / $15,840.44
| Facility | | $11,053.28 | $13,855.52 | $15,840.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,505.07 / $15,054.86 / $19,579.50
| Facility | | $8,505.07 | $15,054.86 | $19,579.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,094.87 / $18,094.87 / $18,094.87
| Facility | | $18,094.87 | $18,094.87 | $18,094.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,286.00 / $12,073.63 / $18,593.68
| Facility | | $1,286.00 | $12,073.63 | $18,593.68 |