- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,198.80 / $12,198.80 / $14,458.00
| Facility | | $12,198.80 | $12,198.80 | $14,458.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,903.93 / $14,487.18 / $21,671.94
| Facility | | $8,903.93 | $14,487.18 | $21,671.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,977.14 / $12,348.82 / $21,010.08
| Facility | | $9,977.14 | $12,348.82 | $21,010.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,926.37 / $14,322.38 / $23,443.68
| Facility | | $8,926.37 | $14,322.38 | $23,443.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.97 / $8,266.60 / $11,962.77
| Facility | | $130.97 | $8,266.60 | $11,962.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,157.77 / $14,149.91 / $16,629.68
| Facility | | $10,157.77 | $14,149.91 | $16,629.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,167.39 / $15,092.94 / $19,025.88
| Facility | | $9,167.39 | $15,092.94 | $19,025.88 |