- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,302.60 / $11,302.60 / $13,395.80
| Facility | | $11,302.60 | $11,302.60 | $13,395.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,145.50 / $13,253.17 / $19,825.93
| Facility | | $8,145.50 | $13,253.17 | $19,825.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,244.10 / $11,441.53 / $19,466.43
| Facility | | $9,244.10 | $11,441.53 | $19,466.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,270.54 / $13,270.10 / $21,721.24
| Facility | | $8,270.54 | $13,270.10 | $21,721.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $119.82 / $7,562.46 / $11,083.85
| Facility | | $119.82 | $7,562.46 | $11,083.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,411.46 / $13,110.29 / $15,407.88
| Facility | | $9,411.46 | $13,110.29 | $15,407.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,493.85 / $13,984.04 / $17,628.03
| Facility | | $8,493.85 | $13,984.04 | $17,628.03 |