- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,040.40 / $17,410.90 / $27,895.90
| Facility | | $13,040.40 | $17,410.90 | $27,895.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,681.55 / $14,681.55 / $14,681.55
| Facility | | $14,681.55 | $14,681.55 | $14,681.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,612.02 / $16,195.08 / $23,634.00
| Facility | | $10,612.02 | $16,195.08 | $23,634.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,376.09 / $15,705.37 / $28,426.00
| Facility | | $11,376.09 | $15,705.37 | $28,426.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.00 / $166.56 / $265.45
| Facility | | $120.00 | $166.56 | $265.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,530.18 / $17,341.28 / $28,539.70
| Facility | | $12,530.18 | $17,341.28 | $28,539.70 |