- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,654.40 / $9,654.40 / $11,442.40
| Facility | | $9,654.40 | $9,654.40 | $11,442.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,052.53 / $11,474.85 / $17,165.68
| Facility | | $7,052.53 | $11,474.85 | $17,165.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,896.11 / $9,773.10 / $16,627.80
| Facility | | $7,896.11 | $9,773.10 | $16,627.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,064.51 / $11,335.02 / $18,553.80
| Facility | | $7,064.51 | $11,335.02 | $18,553.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $103.75 / $6,547.72 / $9,467.57
| Facility | | $103.75 | $6,547.72 | $9,467.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,039.07 / $11,198.52 / $13,161.07
| Facility | | $8,039.07 | $11,198.52 | $13,161.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,255.25 / $11,944.86 / $15,057.47
| Facility | | $7,255.25 | $11,944.86 | $15,057.47 |