- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $15,848.93 / $19,054.61
| Facility | | $12,882.50 | $15,848.93 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $14,125.38 / $22,908.68
| Facility | | $13,803.84 | $14,125.38 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $151.36
| Facility | | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,302.69 / $16,218.10 / $25,118.86
| Facility | | $12,302.69 | $16,218.10 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $23,988.33 / $23,988.33
| Facility | | $10,471.29 | $23,988.33 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $17,782.79 / $26,915.35
| Facility | | $12,882.50 | $17,782.79 | $26,915.35 |