- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,101.10 / $11,101.10 / $13,156.90
| Facility | | $11,101.10 | $11,101.10 | $13,156.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,755.39 / $12,618.44 / $18,876.41
| Facility | | $7,755.39 | $12,618.44 | $18,876.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,079.29 / $11,237.54 / $19,119.38
| Facility | | $9,079.29 | $11,237.54 | $19,119.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,123.09 / $13,033.51 / $21,333.98
| Facility | | $8,123.09 | $13,033.51 | $21,333.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.09 / $7,200.27 / $10,886.24
| Facility | | $114.09 | $7,200.27 | $10,886.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,243.67 / $12,876.56 / $15,133.18
| Facility | | $9,243.67 | $12,876.56 | $15,133.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,342.41 / $13,734.73 / $17,313.74
| Facility | | $8,342.41 | $13,734.73 | $17,313.74 |