- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,153.50 / $17,423.59 / $30,484.80
| Facility | | $13,153.50 | $17,423.59 | $30,484.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,014.74 / $14,014.74 / $14,014.74
| Facility | | $14,014.74 | $14,014.74 | $14,014.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,939.30 / $14,302.02 / $29,076.59
| Facility | | $5,939.30 | $14,302.02 | $29,076.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,961.65 / $17,696.37 / $27,217.58
| Facility | | $11,961.65 | $17,696.37 | $27,217.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $17,955.90 / $30,843.29
| Facility | | $3,496.00 | $17,955.90 | $30,843.29 |