- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,947.00 / $13,530.40 / $18,593.80
| Facility | | $8,947.00 | $13,530.40 | $18,593.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,307.79 / $10,307.79 / $10,307.79
| Facility | | $10,307.79 | $10,307.79 | $10,307.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,061.57 / $12,917.52 / $19,570.32
| Facility | | $8,061.57 | $12,917.52 | $19,570.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,564.00 / $11,242.09 / $18,740.93
| Facility | | $6,564.00 | $11,242.09 | $18,740.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,564.00 / $11,102.57 / $17,084.75
| Facility | | $6,564.00 | $11,102.57 | $17,084.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,264.00 / $14,699.66 / $20,667.59
| Facility | | $7,264.00 | $14,699.66 | $20,667.59 |