- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,299.32 / $11,985.60 / $24,357.80
| Facility | | $9,299.32 | $11,985.60 | $24,357.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,776.38 / $11,776.38 / $11,776.38
| Facility | | $11,776.38 | $11,776.38 | $11,776.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,054.31 / $12,603.29 / $14,408.82
| Facility | | $10,054.31 | $12,603.29 | $14,408.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,422.84 / $13,139.21 / $17,088.11
| Facility | | $7,422.84 | $13,139.21 | $17,088.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,542.84 / $13,542.84 / $13,542.84
| Facility | | $13,542.84 | $13,542.84 | $13,542.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,286.00 / $10,537.32 / $16,227.74
| Facility | | $1,286.00 | $10,537.32 | $16,227.74 |