- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,123.60 / $10,123.60 / $11,998.40
| Facility | | $10,123.60 | $10,123.60 | $11,998.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,327.14 / $11,921.65 / $17,834.06
| Facility | | $7,327.14 | $11,921.65 | $17,834.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,279.84 / $10,248.06 / $17,435.88
| Facility | | $8,279.84 | $10,248.06 | $17,435.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,407.83 / $11,885.88 / $19,455.48
| Facility | | $7,407.83 | $11,885.88 | $19,455.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.79 / $6,802.67 / $9,927.68
| Facility | | $107.79 | $6,802.67 | $9,927.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,429.75 / $11,742.75 / $13,800.67
| Facility | | $8,429.75 | $11,742.75 | $13,800.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,607.85 / $12,525.36 / $15,789.23
| Facility | | $7,607.85 | $12,525.36 | $15,789.23 |