- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,482.35 / $14,319.60 / $25,198.40
| Facility | | $8,482.35 | $14,319.60 | $25,198.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,874.49 / $14,874.49 / $14,874.49
| Facility | | $14,874.49 | $14,874.49 | $14,874.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,702.53 / $11,479.54 / $18,645.63
| Facility | | $7,702.53 | $11,479.54 | $18,645.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,716.03 / $13,199.19 / $18,366.43
| Facility | | $7,716.03 | $13,199.19 | $18,366.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,027.35 / $27,027.35 / $31,718.89
| Facility | | $27,027.35 | $27,027.35 | $31,718.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,158.00 / $12,763.00 / $20,873.48
| Facility | | $3,158.00 | $12,763.00 | $20,873.48 |