- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,523.30 / $13,563.10 / $27,563.70
| Facility | | $10,523.30 | $13,563.10 | $27,563.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,392.91 / $12,392.91 / $12,392.91
| Facility | | $12,392.91 | $12,392.91 | $12,392.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,688.66 / $12,144.94 / $13,884.81
| Facility | | $9,688.66 | $12,144.94 | $13,884.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,399.82 / $14,868.56 / $19,337.21
| Facility | | $8,399.82 | $14,868.56 | $19,337.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,251.85 / $14,251.85 / $14,251.85
| Facility | | $14,251.85 | $14,251.85 | $14,251.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.00 / $13,510.20 / $18,993.58
| Facility | | $1,518.00 | $13,510.20 | $18,993.58 |