- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,822.80 / $10,822.80 / $12,827.20
| Facility | | $10,822.80 | $10,822.80 | $12,827.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,773.91 / $12,648.58 / $18,921.50
| Facility | | $7,773.91 | $12,648.58 | $18,921.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,851.76 / $10,955.92 / $18,640.23
| Facility | | $8,851.76 | $10,955.92 | $18,640.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,919.51 / $12,706.88 / $20,799.33
| Facility | | $7,919.51 | $12,706.88 | $20,799.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.36 / $7,217.47 / $10,613.42
| Facility | | $114.36 | $7,217.47 | $10,613.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,012.02 / $12,553.86 / $14,753.93
| Facility | | $9,012.02 | $12,553.86 | $14,753.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,133.34 / $13,390.52 / $16,879.84
| Facility | | $8,133.34 | $13,390.52 | $16,879.84 |