- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,825.16 / $14,639.50 / $19,645.00
| Facility | | $8,825.16 | $14,639.50 | $19,645.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,693.15 / $15,693.15 / $15,693.15
| Facility | | $15,693.15 | $15,693.15 | $15,693.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,057.98 / $10,776.83 / $16,945.96
| Facility | | $6,057.98 | $10,776.83 | $16,945.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,246.65 / $11,787.00 / $27,032.31
| Facility | | $7,246.65 | $11,787.00 | $27,032.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,552.65 / $11,610.98 / $16,448.37
| Facility | | $8,552.65 | $11,610.98 | $16,448.37 |