- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,627.86 / $11,120.10 / $22,599.10
| Facility | | $8,627.86 | $11,120.10 | $22,599.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,650.22 / $10,650.22 / $12,919.28
| Facility | | $10,650.22 | $10,650.22 | $12,919.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,795.48 / $11,025.32 / $12,604.79
| Facility | | $8,795.48 | $11,025.32 | $12,604.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,886.88 / $12,190.50 / $15,854.27
| Facility | | $6,886.88 | $12,190.50 | $15,854.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,247.75 / $12,247.75 / $14,857.17
| Facility | | $12,247.75 | $12,247.75 | $14,857.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.00 / $11,076.80 / $15,572.54
| Facility | | $1,518.00 | $11,076.80 | $15,572.54 |