- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,928.20 / $12,928.20 / $15,322.40
| Facility | | $12,928.20 | $12,928.20 | $15,322.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,408.81 / $16,935.68 / $25,334.76
| Facility | | $10,408.81 | $16,935.68 | $25,334.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,573.65 / $13,087.13 / $22,266.23
| Facility | | $10,573.65 | $13,087.13 | $22,266.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,460.06 / $15,178.69 / $24,845.33
| Facility | | $9,460.06 | $15,178.69 | $24,845.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $153.12 / $9,663.76 / $13,807.19
| Facility | | $153.12 | $9,663.76 | $13,807.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,765.09 / $14,995.90 / $17,623.93
| Facility | | $10,765.09 | $14,995.90 | $17,623.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,715.49 / $15,995.32 / $20,163.40
| Facility | | $9,715.49 | $15,995.32 | $20,163.40 |