- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,871.60 / $19,167.50 / $38,953.40
| Facility | | $14,871.60 | $19,167.50 | $38,953.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,541.38 / $7,541.38 / $7,541.38
| Facility | | $7,541.38 | $7,541.38 | $7,541.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,940.07 / $14,967.13 / $17,111.30
| Facility | | $11,940.07 | $14,967.13 | $17,111.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,875.14 / $26,875.14 / $26,875.14
| Facility | | $26,875.14 | $26,875.14 | $26,875.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,672.59 / $8,672.59 / $11,058.40
| Facility | | $8,672.59 | $8,672.59 | $11,058.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,286.00 / $16,851.43 / $25,951.63
| Facility | | $1,286.00 | $16,851.43 | $25,951.63 |