- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,925.00 / $15,095.50 / $18,227.50
| Facility | | $7,925.00 | $15,095.50 | $18,227.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,916.00 / $13,631.00 / $24,748.39
| Facility | | $6,916.00 | $13,631.00 | $24,748.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,677.54 / $13,186.50 / $15,802.48
| Facility | | $11,677.54 | $13,186.50 | $15,802.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,527.35 / $12,019.00 / $15,554.00
| Facility | | $7,527.35 | $12,019.00 | $15,554.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,922.95 / $14,939.14 / $22,945.83
| Facility | | $8,922.95 | $14,939.14 | $22,945.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,808.77 / $13,594.92 / $15,759.24
| Facility | | $9,808.77 | $13,594.92 | $15,759.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,775.00 / $12,428.94 / $17,904.16
| Facility | | $3,775.00 | $12,428.94 | $17,904.16 |