- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,889.10 / $12,889.10 / $15,276.10
| Facility | | $12,889.10 | $12,889.10 | $15,276.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,639.48 / $15,683.95 / $23,462.24
| Facility | | $9,639.48 | $15,683.95 | $23,462.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,541.67 / $13,047.55 / $22,198.89
| Facility | | $10,541.67 | $13,047.55 | $22,198.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,431.45 / $15,132.79 / $24,770.19
| Facility | | $9,431.45 | $15,132.79 | $24,770.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.80 / $8,949.50 / $12,786.68
| Facility | | $141.80 | $8,949.50 | $12,786.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,732.53 / $14,950.55 / $17,570.64
| Facility | | $10,732.53 | $14,950.55 | $17,570.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,686.10 / $15,946.95 / $20,102.41
| Facility | | $9,686.10 | $15,946.95 | $20,102.41 |