- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,451.87 / $12,814.10 / $21,274.40
| Facility | | $8,451.87 | $12,814.10 | $21,274.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,849.13 / $12,849.13 / $12,849.13
| Facility | | $12,849.13 | $12,849.13 | $12,849.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,456.45 / $11,170.20 / $18,922.56
| Facility | | $7,456.45 | $11,170.20 | $18,922.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,045.32 / $13,667.68 / $19,652.46
| Facility | | $11,045.32 | $13,667.68 | $19,652.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,866.25 / $13,721.51 / $33,342.31
| Facility | | $6,866.25 | $13,721.51 | $33,342.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,866.25 / $13,100.81 / $18,412.54
| Facility | | $6,866.25 | $13,100.81 | $18,412.54 |