- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,687.70 / $15,063.90 / $30,613.90
| Facility | | $11,687.70 | $15,063.90 | $30,613.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,216.61 / $14,525.43 / $15,919.77
| Facility | | $14,216.61 | $14,525.43 | $15,919.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,277.64 / $14,136.76 / $16,161.97
| Facility | | $11,277.64 | $14,136.76 | $16,161.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,329.32 / $16,513.88 / $21,477.01
| Facility | | $9,329.32 | $16,513.88 | $21,477.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,704.24 / $16,704.24 / $18,307.74
| Facility | | $16,704.24 | $16,704.24 | $18,307.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.00 / $15,005.20 / $21,095.35
| Facility | | $1,518.00 | $15,005.20 | $21,095.35 |