- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,181.50 / $13,811.70 / $24,304.70
| Facility | | $8,181.50 | $13,811.70 | $24,304.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,008.00 / $8,868.39 / $14,563.77
| Facility | | $6,008.00 | $8,868.39 | $14,563.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,442.36 / $12,731.04 / $17,715.00
| Facility | | $7,442.36 | $12,731.04 | $17,715.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,011.45 / $27,011.45 / $31,700.23
| Facility | | $27,011.45 | $27,011.45 | $31,700.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $12,036.81 / $17,193.20
| Facility | | $1,787.00 | $12,036.81 | $17,193.20 |