- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,736.60 / $14,586.50 / $22,967.50
| Facility | | $10,736.60 | $14,586.50 | $22,967.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,737.56 / $13,542.02 / $19,658.34
| Facility | | $8,737.56 | $13,542.02 | $19,658.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,366.28 / $13,137.84 / $23,404.00
| Facility | | $9,366.28 | $13,137.84 | $23,404.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $99.56 / $137.13 / $218.56
| Facility | | $99.56 | $137.13 | $218.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,316.48 / $14,277.61 / $23,497.62
| Facility | | $10,316.48 | $14,277.61 | $23,497.62 |