- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,971.16 / $14,881.60 / $19,970.00
| Facility | | $8,971.16 | $14,881.60 | $19,970.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,134.79 / $10,134.79 / $12,917.14
| Facility | | $10,134.79 | $10,134.79 | $12,917.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,138.62 / $12,671.98 / $19,988.89
| Facility | | $7,138.62 | $12,671.98 | $19,988.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,366.53 / $11,982.00 / $27,479.52
| Facility | | $7,366.53 | $11,982.00 | $27,479.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,746.06 / $11,870.17 / $16,926.57
| Facility | | $8,746.06 | $11,870.17 | $16,926.57 |