- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,483.00 / $12,483.00 / $14,794.90
| Facility | | $12,483.00 | $12,483.00 | $14,794.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,094.62 / $14,797.45 / $22,136.09
| Facility | | $9,094.62 | $14,797.45 | $22,136.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,209.59 / $12,636.53 / $21,499.59
| Facility | | $10,209.59 | $12,636.53 | $21,499.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,134.35 / $14,656.08 / $23,989.89
| Facility | | $9,134.35 | $14,656.08 | $23,989.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $133.79 / $8,443.65 / $12,241.48
| Facility | | $133.79 | $8,443.65 | $12,241.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,394.44 / $14,479.58 / $17,017.14
| Facility | | $10,394.44 | $14,479.58 | $17,017.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,380.98 / $15,444.59 / $19,469.16
| Facility | | $9,380.98 | $15,444.59 | $19,469.16 |