- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $15,135.61 / $22,908.68
| Facility | | $10,964.78 | $15,135.61 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $13,489.63 / $19,952.62
| Facility | | $8,317.64 | $13,489.63 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $13,182.57 / $23,442.29
| Facility | | $9,332.54 | $13,182.57 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $147.91 / $218.78
| Facility | | $100.00 | $147.91 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $14,454.40 / $21,379.62
| Facility | | $9,772.37 | $14,454.40 | $21,379.62 |