- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,079.70 / $13,694.00 / $21,562.20
| Facility | | $10,079.70 | $13,694.00 | $21,562.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,048.70 / $12,740.76 / $18,981.91
| Facility | | $8,048.70 | $12,740.76 | $18,981.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,793.19 / $12,139.53 / $21,972.00
| Facility | | $8,793.19 | $12,139.53 | $21,972.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.47 / $128.74 / $205.19
| Facility | | $93.47 | $128.74 | $205.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,685.26 / $13,404.02 / $22,059.89
| Facility | | $9,685.26 | $13,404.02 | $22,059.89 |