- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,501.07 / $9,625.12 / $15,980.00
| Facility | | $7,501.07 | $9,625.12 | $15,980.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,377.03 / $9,762.23 / $17,919.84
| Facility | | $6,377.03 | $9,762.23 | $17,919.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,296.56 / $10,724.30 / $20,419.00
| Facility | | $8,296.56 | $10,724.30 | $20,419.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,157.50 / $10,306.75 / $28,515.59
| Facility | | $5,157.50 | $10,306.75 | $28,515.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,892.90 / $9,738.19 / $13,653.76
| Facility | | $6,892.90 | $9,738.19 | $13,653.76 |