- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,361.20 / $10,361.20 / $12,280.00
| Facility | | $10,361.20 | $10,361.20 | $12,280.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,538.54 / $12,265.61 / $18,348.61
| Facility | | $7,538.54 | $12,265.61 | $18,348.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,474.17 / $10,488.58 / $17,845.09
| Facility | | $8,474.17 | $10,488.58 | $17,845.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,581.69 / $12,164.85 / $19,912.09
| Facility | | $7,581.69 | $12,164.85 | $19,912.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $110.90 / $6,998.94 / $10,160.68
| Facility | | $110.90 | $6,998.94 | $10,160.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,627.60 / $12,018.35 / $14,124.58
| Facility | | $8,627.60 | $12,018.35 | $14,124.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,786.40 / $12,819.33 / $16,159.81
| Facility | | $7,786.40 | $12,819.33 | $16,159.81 |