- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,795.17 / $10,046.90 / $20,418.00
| Facility | | $7,795.17 | $10,046.90 | $20,418.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,445.64 / $12,445.64 / $12,445.64
| Facility | | $12,445.64 | $12,445.64 | $12,445.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,701.37 / $9,653.83 / $11,036.82
| Facility | | $7,701.37 | $9,653.83 | $11,036.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,222.22 / $11,013.98 / $14,324.15
| Facility | | $6,222.22 | $11,013.98 | $14,324.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,240.92 / $14,240.92 / $14,240.92
| Facility | | $14,240.92 | $14,240.92 | $14,240.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,286.00 / $8,832.94 / $13,602.94
| Facility | | $1,286.00 | $8,832.94 | $13,602.94 |