- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,651.50 / $12,651.50 / $14,994.50
| Facility | | $12,651.50 | $12,651.50 | $14,994.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,186.51 / $16,574.00 / $24,793.70
| Facility | | $10,186.51 | $16,574.00 | $24,793.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,347.34 / $12,807.03 / $21,789.67
| Facility | | $10,347.34 | $12,807.03 | $21,789.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,257.59 / $14,853.82 / $24,313.57
| Facility | | $9,257.59 | $14,853.82 | $24,313.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $149.85 / $9,457.37 / $13,512.31
| Facility | | $149.85 | $9,457.37 | $13,512.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,534.68 / $14,674.95 / $17,246.74
| Facility | | $10,534.68 | $14,674.95 | $17,246.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,507.54 / $15,652.98 / $19,731.84
| Facility | | $9,507.54 | $15,652.98 | $19,731.84 |