- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,816.90 / $11,816.90 / $14,005.30
| Facility | | $11,816.90 | $11,816.90 | $14,005.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,391.43 / $12,026.25 / $17,990.55
| Facility | | $7,391.43 | $12,026.25 | $17,990.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,664.73 / $11,962.15 / $20,352.22
| Facility | | $9,664.73 | $11,962.15 | $20,352.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,646.87 / $13,873.93 / $22,709.62
| Facility | | $8,646.87 | $13,873.93 | $22,709.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.73 / $6,862.36 / $10,873.15
| Facility | | $108.73 | $6,862.36 | $10,873.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,839.71 / $13,706.85 / $16,108.99
| Facility | | $9,839.71 | $13,706.85 | $16,108.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,880.34 / $14,620.36 / $18,430.15
| Facility | | $8,880.34 | $14,620.36 | $18,430.15 |