- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,840.90 / $11,840.90 / $14,033.80
| Facility | | $11,840.90 | $11,840.90 | $14,033.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,533.78 / $15,511.97 / $23,204.97
| Facility | | $9,533.78 | $15,511.97 | $23,204.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,684.41 / $11,986.51 / $20,393.66
| Facility | | $9,684.41 | $11,986.51 | $20,393.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,664.48 / $13,902.18 / $22,755.86
| Facility | | $8,664.48 | $13,902.18 | $22,755.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $140.25 / $8,851.36 / $12,646.47
| Facility | | $140.25 | $8,851.36 | $12,646.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,859.75 / $13,734.76 / $16,141.79
| Facility | | $9,859.75 | $13,734.76 | $16,141.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,898.42 / $14,650.13 / $18,467.68
| Facility | | $8,898.42 | $14,650.13 | $18,467.68 |