- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,105.60 / $12,105.60 / $14,347.50
| Facility | | $12,105.60 | $12,105.60 | $14,347.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,875.60 / $14,441.08 / $21,602.98
| Facility | | $8,875.60 | $14,441.08 | $21,602.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,900.87 / $12,254.43 / $20,849.50
| Facility | | $9,900.87 | $12,254.43 | $20,849.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,858.15 / $14,212.92 / $23,264.50
| Facility | | $8,858.15 | $14,212.92 | $23,264.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.56 / $8,240.29 / $11,871.34
| Facility | | $130.56 | $8,240.29 | $11,871.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,080.14 / $14,041.76 / $16,502.59
| Facility | | $10,080.14 | $14,041.76 | $16,502.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,097.32 / $14,977.59 / $18,880.47
| Facility | | $9,097.32 | $14,977.59 | $18,880.47 |