- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,265.44 / $12,211.00 / $20,273.20
| Facility | | $9,265.44 | $12,211.00 | $20,273.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,705.03 / $11,705.03 / $11,705.03
| Facility | | $11,705.03 | $11,705.03 | $11,705.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,900.89 / $11,496.63 / $19,431.00
| Facility | | $7,900.89 | $11,496.63 | $19,431.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,525.53 / $13,347.98 / $20,945.00
| Facility | | $10,525.53 | $13,347.98 | $20,945.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,543.13 / $12,511.50 / $33,581.78
| Facility | | $6,543.13 | $12,511.50 | $33,581.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,543.13 / $12,484.28 / $17,546.04
| Facility | | $6,543.13 | $12,484.28 | $17,546.04 |