- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,764.36 / $10,007.20 / $20,337.30
| Facility | | $7,764.36 | $10,007.20 | $20,337.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,486.80 / $11,486.80 / $12,272.48
| Facility | | $11,486.80 | $11,486.80 | $12,272.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,618.30 / $9,549.70 / $10,917.78
| Facility | | $7,618.30 | $9,549.70 | $10,917.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,197.62 / $10,970.44 / $14,267.53
| Facility | | $6,197.62 | $10,970.44 | $14,267.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,209.82 / $13,209.82 / $14,113.35
| Facility | | $13,209.82 | $13,209.82 | $14,113.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,286.00 / $8,798.02 / $13,549.17
| Facility | | $1,286.00 | $8,798.02 | $13,549.17 |