- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,681.60 / $13,681.60 / $16,215.40
| Facility | | $13,681.60 | $13,681.60 | $16,215.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,249.70 / $16,676.83 / $24,947.53
| Facility | | $10,249.70 | $16,676.83 | $24,947.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,189.84 / $13,849.79 / $23,563.82
| Facility | | $11,189.84 | $13,849.79 | $23,563.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,011.36 / $16,063.25 / $26,293.22
| Facility | | $10,011.36 | $16,063.25 | $26,293.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $150.78 / $9,516.04 / $13,596.15
| Facility | | $150.78 | $9,516.04 | $13,596.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,392.43 / $15,869.81 / $18,651.00
| Facility | | $11,392.43 | $15,869.81 | $18,651.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,281.67 / $16,927.47 / $21,338.45
| Facility | | $10,281.67 | $16,927.47 | $21,338.45 |