- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,899.60 / $13,899.60 / $16,473.80
| Facility | | $13,899.60 | $13,899.60 | $16,473.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,622.04 / $15,655.59 / $23,419.80
| Facility | | $9,622.04 | $15,655.59 | $23,419.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,368.18 / $14,070.53 / $23,939.37
| Facility | | $11,368.18 | $14,070.53 | $23,939.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,170.91 / $16,319.26 / $26,712.27
| Facility | | $10,170.91 | $16,319.26 | $26,712.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.54 / $8,933.31 / $13,630.65
| Facility | | $141.54 | $8,933.31 | $13,630.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,574.00 / $16,122.73 / $18,948.25
| Facility | | $11,574.00 | $16,122.73 | $18,948.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,445.53 / $17,197.25 / $21,678.53
| Facility | | $10,445.53 | $17,197.25 | $21,678.53 |