- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,842.47 / $10,107.90 / $20,541.90
| Facility | | $7,842.47 | $10,107.90 | $20,541.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,302.16 / $11,302.16 / $13,223.85
| Facility | | $11,302.16 | $11,302.16 | $13,223.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,716.28 / $9,672.52 / $11,058.19
| Facility | | $7,716.28 | $9,672.52 | $11,058.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,259.97 / $11,080.80 / $14,411.06
| Facility | | $6,259.97 | $11,080.80 | $14,411.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,087.37 / $12,997.48 / $15,868.62
| Facility | | $9,087.37 | $12,997.48 | $15,868.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,286.00 / $8,886.53 / $13,685.47
| Facility | | $1,286.00 | $8,886.53 | $13,685.47 |