- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,770.20 / $10,770.20 / $12,764.80
| Facility | | $10,770.20 | $10,770.20 | $12,764.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,632.25 / $12,418.09 / $18,576.70
| Facility | | $7,632.25 | $12,418.09 | $18,576.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,808.70 / $10,902.64 / $18,549.58
| Facility | | $8,808.70 | $10,902.64 | $18,549.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,881.00 / $12,645.08 / $20,698.18
| Facility | | $7,881.00 | $12,645.08 | $20,698.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.27 / $7,085.95 / $10,561.80
| Facility | | $112.27 | $7,085.95 | $10,561.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,968.19 / $12,492.81 / $14,682.18
| Facility | | $8,968.19 | $12,492.81 | $14,682.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,093.79 / $13,325.40 / $16,797.75
| Facility | | $8,093.79 | $13,325.40 | $16,797.75 |