- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,612.80 / $13,678.50 / $27,798.40
| Facility | | $10,612.80 | $13,678.50 | $27,798.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,567.07 / $15,014.57 / $15,865.06
| Facility | | $11,567.07 | $15,014.57 | $15,865.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,655.68 / $13,357.12 / $15,270.64
| Facility | | $10,655.68 | $13,357.12 | $15,270.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,471.32 / $14,995.13 / $19,501.81
| Facility | | $8,471.32 | $14,995.13 | $19,501.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,722.21 / $16,689.52 / $18,244.82
| Facility | | $12,722.21 | $16,689.52 | $18,244.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,286.00 / $12,025.72 / $18,519.91
| Facility | | $1,286.00 | $12,025.72 | $18,519.91 |