- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,755.20 / $11,755.20 / $13,932.20
| Facility | | $11,755.20 | $11,755.20 | $13,932.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,514.91 / $13,854.22 / $20,725.07
| Facility | | $8,514.91 | $13,854.22 | $20,725.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,614.31 / $11,899.74 / $20,246.03
| Facility | | $9,614.31 | $11,899.74 | $20,246.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,601.76 / $13,801.54 / $22,591.13
| Facility | | $8,601.76 | $13,801.54 | $22,591.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.26 / $7,905.42 / $11,527.73
| Facility | | $125.26 | $7,905.42 | $11,527.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,788.37 / $13,635.33 / $16,024.94
| Facility | | $9,788.37 | $13,635.33 | $16,024.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,598.70 / $14,814.00 / $19,501.84
| Facility | | $8,598.70 | $14,814.00 | $19,501.84 |