- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,466.50 / $13,466.50 / $15,960.50
| Facility | | $13,466.50 | $13,466.50 | $15,960.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,739.73 / $15,847.07 / $23,706.25
| Facility | | $9,739.73 | $15,847.07 | $23,706.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,013.96 / $13,632.11 / $23,193.45
| Facility | | $11,013.96 | $13,632.11 | $23,193.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,854.00 / $15,810.77 / $25,879.95
| Facility | | $9,854.00 | $15,810.77 | $25,879.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $143.28 / $9,042.57 / $13,205.94
| Facility | | $143.28 | $9,042.57 | $13,205.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,213.37 / $15,620.37 / $18,357.84
| Facility | | $11,213.37 | $15,620.37 | $18,357.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,120.06 / $16,661.40 / $21,003.06
| Facility | | $10,120.06 | $16,661.40 | $21,003.06 |