- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,985.07 / $11,660.60 / $15,326.00
| Facility | | $7,985.07 | $11,660.60 | $15,326.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,225.82 / $10,225.82 / $10,225.82
| Facility | | $10,225.82 | $10,225.82 | $10,225.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,825.57 / $10,418.46 / $17,621.45
| Facility | | $3,825.57 | $10,418.46 | $17,621.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,111.74 / $11,712.40 / $19,603.91
| Facility | | $8,111.74 | $11,712.40 | $19,603.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,044.12 / $13,071.19 / $19,085.00
| Facility | | $10,044.12 | $13,071.19 | $19,085.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,044.12 / $12,151.41 / $19,085.00
| Facility | | $10,044.12 | $12,151.41 | $19,085.00 |