- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,654.40 / $10,654.40 / $12,627.60
| Facility | | $10,654.40 | $10,654.40 | $12,627.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,187.66 / $11,694.70 / $17,494.57
| Facility | | $7,187.66 | $11,694.70 | $17,494.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,714.00 / $10,785.42 / $18,350.15
| Facility | | $8,714.00 | $10,785.42 | $18,350.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,796.27 / $12,509.13 / $20,475.65
| Facility | | $7,796.27 | $12,509.13 | $20,475.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $105.73 / $6,673.17 / $10,448.25
| Facility | | $105.73 | $6,673.17 | $10,448.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,871.77 / $12,358.49 / $14,524.33
| Facility | | $8,871.77 | $12,358.49 | $14,524.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,006.77 / $13,182.14 / $16,617.16
| Facility | | $8,006.77 | $13,182.14 | $16,617.16 |