- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,809.20 / $13,928.60 / $28,312.70
| Facility | | $10,809.20 | $13,928.60 | $28,312.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,402.01 / $11,402.01 / $16,077.59
| Facility | | $11,402.01 | $11,402.01 | $16,077.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,772.83 / $13,503.97 / $15,438.53
| Facility | | $10,772.83 | $13,503.97 | $15,438.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,628.04 / $15,272.55 / $19,862.61
| Facility | | $8,628.04 | $15,272.55 | $19,862.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,112.31 / $13,112.31 / $18,489.23
| Facility | | $13,112.31 | $13,112.31 | $18,489.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $15,237.86 / $21,481.12
| Facility | | $2,000.00 | $15,237.86 | $21,481.12 |