- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,574.80 / $12,574.80 / $14,903.60
| Facility | | $12,574.80 | $12,574.80 | $14,903.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,131.34 / $13,230.12 / $19,791.46
| Facility | | $8,131.34 | $13,230.12 | $19,791.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,284.62 / $12,729.39 / $21,657.58
| Facility | | $10,284.62 | $12,729.39 | $21,657.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,201.46 / $14,763.78 / $24,166.18
| Facility | | $9,201.46 | $14,763.78 | $24,166.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $119.62 / $7,549.31 / $11,961.59
| Facility | | $119.62 | $7,549.31 | $11,961.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,470.82 / $14,585.99 / $17,142.18
| Facility | | $10,470.82 | $14,585.99 | $17,142.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,449.91 / $15,558.09 / $19,612.23
| Facility | | $9,449.91 | $15,558.09 | $19,612.23 |