- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,973.20 / $10,973.20 / $13,005.40
| Facility | | $10,973.20 | $10,973.20 | $13,005.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,841.48 / $12,758.50 / $19,085.95
| Facility | | $7,841.48 | $12,758.50 | $19,085.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,974.75 / $11,108.15 / $18,899.23
| Facility | | $8,974.75 | $11,108.15 | $18,899.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,029.55 / $12,883.44 / $21,088.33
| Facility | | $8,029.55 | $12,883.44 | $21,088.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $115.35 / $7,280.19 / $10,760.89
| Facility | | $115.35 | $7,280.19 | $10,760.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,137.24 / $12,728.29 / $14,958.93
| Facility | | $9,137.24 | $12,728.29 | $14,958.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,246.35 / $13,576.58 / $17,114.38
| Facility | | $8,246.35 | $13,576.58 | $17,114.38 |