- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,399.62 / $13,741.20 / $18,750.00
| Facility | | $8,399.62 | $13,741.20 | $18,750.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,951.55 / $12,026.49 / $16,242.69
| Facility | | $7,951.55 | $12,026.49 | $16,242.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,438.10 / $11,477.78 / $16,339.00
| Facility | | $7,438.10 | $11,477.78 | $16,339.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,021.00 / $12,821.00 / $19,893.00
| Facility | | $8,021.00 | $12,821.00 | $19,893.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,274.00 / $11,185.58 / $19,119.55
| Facility | | $5,274.00 | $11,185.58 | $19,119.55 |