- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $12,882.50 / $17,378.01
| Facility | | $5,011.87 | $12,882.50 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,703.96 / $25,703.96 / $25,703.96
| Facility | | $25,703.96 | $25,703.96 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $15,848.93 / $17,782.79
| Facility | | $11,481.54 | $15,848.93 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $13,489.63 / $19,054.61
| Facility | | $10,964.78 | $13,489.63 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $14,791.08 / $19,498.45
| Facility | | $2,041.74 | $14,791.08 | $19,498.45 |