- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,714.60 / $10,714.60 / $12,698.90
| Facility | | $10,714.60 | $10,714.60 | $12,698.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,589.76 / $12,348.94 / $18,473.25
| Facility | | $7,589.76 | $12,348.94 | $18,473.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,763.20 / $10,846.32 / $18,453.75
| Facility | | $8,763.20 | $10,846.32 | $18,453.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,840.29 / $12,579.76 / $20,591.25
| Facility | | $7,840.29 | $12,579.76 | $20,591.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $111.65 / $7,046.49 / $10,507.24
| Facility | | $111.65 | $7,046.49 | $10,507.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,921.86 / $12,428.27 / $14,606.33
| Facility | | $8,921.86 | $12,428.27 | $14,606.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,674.35 / $13,158.45 / $16,710.98
| Facility | | $7,674.35 | $13,158.45 | $16,710.98 |