- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,757.19 / $9,997.96 / $20,318.50
| Facility | | $7,757.19 | $9,997.96 | $20,318.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,862.71 / $10,862.71 / $11,009.22
| Facility | | $10,862.71 | $10,862.71 | $11,009.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,163.90 / $8,980.10 / $10,266.58
| Facility | | $7,163.90 | $8,980.10 | $10,266.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,191.90 / $10,960.31 / $14,254.36
| Facility | | $6,191.90 | $10,960.31 | $14,254.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,492.12 / $12,492.12 / $12,660.60
| Facility | | $12,492.12 | $12,492.12 | $12,660.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,286.00 / $8,789.90 / $13,536.66
| Facility | | $1,286.00 | $8,789.90 | $13,536.66 |