- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,063.20 / $12,970.10 / $26,358.70
| Facility | | $10,063.20 | $12,970.10 | $26,358.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,473.63 / $14,125.97 / $14,574.49
| Facility | | $12,473.63 | $14,125.97 | $14,574.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,965.56 / $12,492.04 / $14,281.63
| Facility | | $9,965.56 | $12,492.04 | $14,281.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,032.60 / $14,218.54 / $18,491.82
| Facility | | $8,032.60 | $14,218.54 | $18,491.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,344.67 / $14,344.67 / $16,760.66
| Facility | | $14,344.67 | $14,344.67 | $16,760.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,286.00 / $11,402.92 / $17,560.77
| Facility | | $1,286.00 | $11,402.92 | $17,560.77 |