- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,268.00 / $11,268.00 / $13,354.80
| Facility | | $11,268.00 | $11,268.00 | $13,354.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,152.04 / $13,263.81 / $19,841.84
| Facility | | $8,152.04 | $13,263.81 | $19,841.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,215.81 / $11,406.52 / $19,406.87
| Facility | | $9,215.81 | $11,406.52 | $19,406.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,245.23 / $13,229.49 / $21,654.77
| Facility | | $8,245.23 | $13,229.49 | $21,654.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $119.92 / $7,568.53 / $11,049.93
| Facility | | $119.92 | $7,568.53 | $11,049.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,382.67 / $13,070.17 / $15,360.73
| Facility | | $9,382.67 | $13,070.17 | $15,360.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,467.85 / $13,941.25 / $17,574.08
| Facility | | $8,467.85 | $13,941.25 | $17,574.08 |