- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,831.90 / $12,831.90 / $15,208.40
| Facility | | $12,831.90 | $12,831.90 | $15,208.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,556.32 / $13,921.59 / $20,825.84
| Facility | | $8,556.32 | $13,921.59 | $20,825.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,494.93 / $12,989.70 / $22,100.47
| Facility | | $10,494.93 | $12,989.70 | $22,100.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,389.64 / $15,065.69 / $24,660.37
| Facility | | $9,389.64 | $15,065.69 | $24,660.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.87 / $7,943.87 / $12,583.62
| Facility | | $125.87 | $7,943.87 | $12,583.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,684.95 / $14,884.27 / $17,492.74
| Facility | | $10,684.95 | $14,884.27 | $17,492.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,643.16 / $15,876.24 / $20,013.30
| Facility | | $9,643.16 | $15,876.24 | $20,013.30 |