- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,214.53 / $13,642.20 / $22,649.30
| Facility | | $9,214.53 | $13,642.20 | $22,649.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,215.04 / $13,215.04 / $13,215.04
| Facility | | $13,215.04 | $13,215.04 | $13,215.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,478.84 / $12,701.80 / $21,517.11
| Facility | | $8,478.84 | $12,701.80 | $21,517.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,759.16 / $14,550.99 / $20,922.55
| Facility | | $11,759.16 | $14,550.99 | $20,922.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,310.00 / $13,977.89 / $37,914.01
| Facility | | $7,310.00 | $13,977.89 | $37,914.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,310.00 / $13,947.48 / $19,602.50
| Facility | | $7,310.00 | $13,947.48 | $19,602.50 |