- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,857.40 / $10,857.40 / $12,868.20
| Facility | | $10,857.40 | $10,857.40 | $12,868.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,111.72 / $13,198.21 / $19,743.72
| Facility | | $8,111.72 | $13,198.21 | $19,743.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,880.04 / $10,990.93 / $18,699.80
| Facility | | $8,880.04 | $10,990.93 | $18,699.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,944.82 / $12,747.49 / $20,865.80
| Facility | | $7,944.82 | $12,747.49 | $20,865.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $119.33 / $7,531.09 / $10,760.12
| Facility | | $119.33 | $7,531.09 | $10,760.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,040.82 / $12,593.98 / $14,801.08
| Facility | | $9,040.82 | $12,593.98 | $14,801.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,159.34 / $13,433.32 / $16,933.79
| Facility | | $8,159.34 | $13,433.32 | $16,933.79 |