- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,290.58 / $13,752.70 / $18,455.00
| Facility | | $8,290.58 | $13,752.70 | $18,455.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,219.31 / $7,219.31 / $7,219.31
| Facility | | $7,219.31 | $7,219.31 | $7,219.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,453.02 / $11,112.48 / $17,679.33
| Facility | | $6,453.02 | $11,112.48 | $17,679.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,807.68 / $11,073.00 / $25,394.82
| Facility | | $6,807.68 | $11,073.00 | $25,394.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,034.57 / $10,907.64 / $15,452.00
| Facility | | $8,034.57 | $10,907.64 | $15,452.00 |