- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $16,595.87 / $16,982.44
| Facility | | $13,803.84 | $16,595.87 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $17,782.79 / $25,703.96
| Facility | | $10,232.93 | $17,782.79 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $14,454.40 / $25,703.96
| Facility | | $10,715.19 | $14,454.40 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $13,803.84 / $17,782.79
| Facility | | $12,022.64 | $13,803.84 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $16,218.10 / $26,915.35
| Facility | | $10,232.93 | $16,218.10 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.49 / $10,471.29 / $13,803.84
| Facility | | $117.49 | $10,471.29 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,135.61 / $19,054.61 / $19,498.45
| Facility | | $15,135.61 | $19,054.61 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $17,378.01 / $23,988.33
| Facility | | $10,232.93 | $17,378.01 | $23,988.33 |