- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,877.58 / $10,153.10 / $20,633.90
| Facility | | $7,877.58 | $10,153.10 | $20,633.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,638.48 / $8,638.48 / $9,804.66
| Facility | | $8,638.48 | $8,638.48 | $9,804.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,646.70 / $9,585.29 / $10,958.48
| Facility | | $7,646.70 | $9,585.29 | $10,958.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,288.00 / $11,130.41 / $14,475.58
| Facility | | $6,288.00 | $11,130.41 | $14,475.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,934.25 / $9,934.25 / $11,275.36
| Facility | | $9,934.25 | $9,934.25 | $11,275.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,286.00 / $8,926.32 / $13,746.75
| Facility | | $1,286.00 | $8,926.32 | $13,746.75 |