- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,874.00 / $10,874.00 / $12,887.80
| Facility | | $10,874.00 | $10,874.00 | $12,887.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,901.41 / $12,856.02 / $19,231.82
| Facility | | $7,901.41 | $12,856.02 | $19,231.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,893.57 / $11,007.68 / $18,728.29
| Facility | | $8,893.57 | $11,007.68 | $18,728.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,956.93 / $12,766.91 / $20,897.59
| Facility | | $7,956.93 | $12,766.91 | $20,897.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $116.23 / $7,335.84 / $10,663.56
| Facility | | $116.23 | $7,335.84 | $10,663.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,054.59 / $12,613.16 / $14,823.63
| Facility | | $9,054.59 | $12,613.16 | $14,823.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,171.77 / $13,453.78 / $16,959.59
| Facility | | $8,171.77 | $13,453.78 | $16,959.59 |