- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,785.30 / $10,785.30 / $12,782.70
| Facility | | $10,785.30 | $10,785.30 | $12,782.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,000.57 / $13,017.36 / $19,473.18
| Facility | | $8,000.57 | $13,017.36 | $19,473.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,821.01 / $10,917.86 / $18,575.48
| Facility | | $8,821.01 | $10,917.86 | $18,575.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,892.00 / $12,662.74 / $20,727.08
| Facility | | $7,892.00 | $12,662.74 | $20,727.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.69 / $7,427.90 / $10,612.68
| Facility | | $117.69 | $7,427.90 | $10,612.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,980.70 / $12,510.25 / $14,702.68
| Facility | | $8,980.70 | $12,510.25 | $14,702.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,105.09 / $13,344.01 / $16,821.21
| Facility | | $8,105.09 | $13,344.01 | $16,821.21 |