- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,574.80 / $13,574.80 / $16,088.80
| Facility | | $13,574.80 | $13,574.80 | $16,088.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,929.69 / $17,783.18 / $26,602.56
| Facility | | $10,929.69 | $17,783.18 | $26,602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,102.51 / $13,741.71 / $23,379.93
| Facility | | $11,102.51 | $13,741.71 | $23,379.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,933.23 / $15,937.89 / $26,088.03
| Facility | | $9,933.23 | $15,937.89 | $26,088.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $160.78 / $10,147.35 / $14,498.12
| Facility | | $160.78 | $10,147.35 | $14,498.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,303.53 / $15,745.96 / $18,505.45
| Facility | | $11,303.53 | $15,745.96 | $18,505.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,929.70 / $17,107.07 / $22,520.56
| Facility | | $9,929.70 | $17,107.07 | $22,520.56 |