- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,555.20 / $10,555.20 / $12,510.00
| Facility | | $10,555.20 | $10,555.20 | $12,510.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,609.37 / $12,380.85 / $18,521.00
| Facility | | $7,609.37 | $12,380.85 | $18,521.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,632.83 / $10,684.95 / $18,179.21
| Facility | | $8,632.83 | $10,684.95 | $18,179.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,723.64 / $12,392.61 / $20,284.91
| Facility | | $7,723.64 | $12,392.61 | $20,284.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $111.94 / $7,064.70 / $10,350.92
| Facility | | $111.94 | $7,064.70 | $10,350.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,789.12 / $12,243.37 / $14,389.03
| Facility | | $8,789.12 | $12,243.37 | $14,389.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,932.19 / $13,059.34 / $16,462.36
| Facility | | $7,932.19 | $13,059.34 | $16,462.36 |