- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,349.20 / $13,349.20 / $15,821.50
| Facility | | $13,349.20 | $13,349.20 | $15,821.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,785.50 / $15,921.54 / $23,817.65
| Facility | | $9,785.50 | $15,921.54 | $23,817.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,918.03 / $13,513.37 / $22,991.43
| Facility | | $10,918.03 | $13,513.37 | $22,991.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,768.17 / $15,673.05 / $25,654.53
| Facility | | $9,768.17 | $15,673.05 | $25,654.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $143.94 / $9,085.07 / $13,090.91
| Facility | | $143.94 | $9,085.07 | $13,090.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,115.70 / $15,484.31 / $18,197.95
| Facility | | $11,115.70 | $15,484.31 | $18,197.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,031.92 / $16,516.28 / $20,820.12
| Facility | | $10,031.92 | $16,516.28 | $20,820.12 |