- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,860.80 / $16,575.80 / $33,686.50
| Facility | | $12,860.80 | $16,575.80 | $33,686.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,245.89 / $17,291.25 / $20,533.37
| Facility | | $11,245.89 | $17,291.25 | $20,533.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,980.22 / $16,270.98 / $18,601.93
| Facility | | $12,980.22 | $16,270.98 | $18,601.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,265.68 / $18,171.34 / $23,632.61
| Facility | | $10,265.68 | $18,171.34 | $23,632.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,932.77 / $12,932.77 / $23,377.25
| Facility | | $12,932.77 | $12,932.77 | $23,377.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,286.00 / $14,572.96 / $22,442.72
| Facility | | $1,286.00 | $14,572.96 | $22,442.72 |