- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,941.80 / $14,102.40 / $28,659.90
| Facility | | $10,941.80 | $14,102.40 | $28,659.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,863.67 / $14,986.58 / $15,220.92
| Facility | | $13,863.67 | $14,986.58 | $15,220.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,461.85 / $13,114.15 / $14,992.86
| Facility | | $10,461.85 | $13,114.15 | $14,992.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,733.87 / $15,459.86 / $20,106.22
| Facility | | $8,733.87 | $15,459.86 | $20,106.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,943.22 / $15,943.22 / $15,943.22
| Facility | | $15,943.22 | $15,943.22 | $15,943.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,286.00 / $12,398.43 / $19,093.88
| Facility | | $1,286.00 | $12,398.43 | $19,093.88 |