- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,374.56 / $12,082.50 / $24,554.90
| Facility | | $9,374.56 | $12,082.50 | $24,554.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,947.14 / $13,947.14 / $13,947.14
| Facility | | $13,947.14 | $13,947.14 | $13,947.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,609.45 / $10,792.14 / $12,338.21
| Facility | | $8,609.45 | $10,792.14 | $12,338.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,482.90 / $13,245.53 / $17,226.38
| Facility | | $7,482.90 | $13,245.53 | $17,226.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,039.21 / $16,039.21 / $16,039.21
| Facility | | $16,039.21 | $16,039.21 | $16,039.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,286.00 / $10,622.58 / $16,359.04
| Facility | | $1,286.00 | $10,622.58 | $16,359.04 |