- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,278.75 / $13,549.70 / $17,809.00
| Facility | | $9,278.75 | $13,549.70 | $17,809.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,294.22 / $11,294.22 / $11,294.22
| Facility | | $11,294.22 | $11,294.22 | $11,294.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,557.28 / $9,687.79 / $16,385.61
| Facility | | $3,557.28 | $9,687.79 | $16,385.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,864.16 / $13,719.50 / $25,310.62
| Facility | | $9,864.16 | $13,719.50 | $25,310.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,671.40 / $15,188.88 / $22,177.00
| Facility | | $11,671.40 | $15,188.88 | $22,177.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,655.92 / $14,616.02 / $22,177.00
| Facility | | $9,655.92 | $14,616.02 | $22,177.00 |