- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,163.10 / $14,261.60 / $21,734.00
| Facility | | $10,163.10 | $14,261.60 | $21,734.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,858.96 / $12,858.96 / $12,858.96
| Facility | | $12,858.96 | $12,858.96 | $12,858.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,274.54 / $12,845.09 / $19,120.49
| Facility | | $8,274.54 | $12,845.09 | $19,120.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,866.03 / $12,240.09 / $22,154.00
| Facility | | $8,866.03 | $12,240.09 | $22,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $94.24 / $129.81 / $206.89
| Facility | | $94.24 | $129.81 | $206.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,765.48 / $13,515.05 / $22,242.62
| Facility | | $9,765.48 | $13,515.05 | $22,242.62 |