- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,997.20 / $18,242.50 / $24,480.00
| Facility | | $10,997.20 | $18,242.50 | $24,480.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,179.44 / $7,179.44 / $7,179.44
| Facility | | $7,179.44 | $7,179.44 | $7,179.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,779.09 / $14,790.31 / $23,019.33
| Facility | | $8,779.09 | $14,790.31 | $23,019.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,030.18 / $14,688.00 / $33,685.46
| Facility | | $9,030.18 | $14,688.00 | $33,685.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,657.61 / $14,414.80 / $20,749.25
| Facility | | $10,657.61 | $14,414.80 | $20,749.25 |