- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,650.00 / $12,650.00 / $14,992.70
| Facility | | $12,650.00 | $12,650.00 | $14,992.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,373.59 / $15,251.34 / $22,815.08
| Facility | | $9,373.59 | $15,251.34 | $22,815.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,346.11 / $12,805.50 / $21,787.08
| Facility | | $10,346.11 | $12,805.50 | $21,787.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,256.49 / $14,852.06 / $24,310.68
| Facility | | $9,256.49 | $14,852.06 | $24,310.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $137.88 / $8,702.64 / $12,433.98
| Facility | | $137.88 | $8,702.64 | $12,433.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,533.43 / $14,673.20 / $17,244.68
| Facility | | $10,533.43 | $14,673.20 | $17,244.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,506.42 / $15,651.11 / $19,729.50
| Facility | | $9,506.42 | $15,651.11 | $19,729.50 |