- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,874.10 / $14,874.10 / $17,628.70
| Facility | | $14,874.10 | $14,874.10 | $17,628.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,940.58 / $17,800.91 / $26,629.09
| Facility | | $10,940.58 | $17,800.91 | $26,629.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,165.17 / $15,056.97 / $25,617.69
| Facility | | $12,165.17 | $15,056.97 | $25,617.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,883.97 / $17,463.34 / $28,584.99
| Facility | | $10,883.97 | $17,463.34 | $28,584.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $160.94 / $10,157.46 / $14,586.26
| Facility | | $160.94 | $10,157.46 | $14,586.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,385.42 / $17,253.05 / $20,276.66
| Facility | | $12,385.42 | $17,253.05 | $20,276.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,177.84 / $18,402.90 / $23,198.35
| Facility | | $11,177.84 | $18,402.90 | $23,198.35 |