- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,560.57 / $12,541.70 / $16,830.00
| Facility | | $7,560.57 | $12,541.70 | $16,830.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,382.87 / $9,382.87 / $9,382.87
| Facility | | $9,382.87 | $9,382.87 | $9,382.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,142.43 / $10,683.09 / $16,798.56
| Facility | | $6,142.43 | $10,683.09 | $16,798.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,208.25 / $10,098.00 / $23,158.75
| Facility | | $6,208.25 | $10,098.00 | $23,158.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,362.11 / $9,947.20 / $14,265.11
| Facility | | $7,362.11 | $9,947.20 | $14,265.11 |