- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,329.33 / $11,840.30 / $16,384.00
| Facility | | $7,329.33 | $11,840.30 | $16,384.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,047.44 / $9,047.44 / $9,047.44
| Facility | | $9,047.44 | $9,047.44 | $9,047.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,000.00 / $11,093.40 / $16,806.75
| Facility | | $7,000.00 | $11,093.40 | $16,806.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,564.00 / $9,905.96 / $16,958.49
| Facility | | $6,564.00 | $9,905.96 | $16,958.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,564.00 / $10,318.27 / $16,162.81
| Facility | | $6,564.00 | $10,318.27 | $16,162.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,091.82 / $12,952.61 / $18,211.27
| Facility | | $7,091.82 | $12,952.61 | $18,211.27 |