- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,292.20 / $14,554.10 / $29,577.80
| Facility | | $11,292.20 | $14,554.10 | $29,577.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,440.49 / $15,440.49 / $15,440.49
| Facility | | $15,440.49 | $15,440.49 | $15,440.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,911.28 / $13,677.52 / $15,636.94
| Facility | | $10,911.28 | $13,677.52 | $15,636.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,013.58 / $15,954.98 / $20,750.13
| Facility | | $9,013.58 | $15,954.98 | $20,750.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,756.56 / $17,756.56 / $17,756.56
| Facility | | $17,756.56 | $17,756.56 | $17,756.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,286.00 / $12,795.50 / $19,705.38
| Facility | | $1,286.00 | $12,795.50 | $19,705.38 |