- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,788.76 / $16,237.90 / $21,790.00
| Facility | | $9,788.76 | $16,237.90 | $21,790.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,223.18 / $12,223.18 / $12,223.18
| Facility | | $12,223.18 | $12,223.18 | $12,223.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,767.63 / $13,606.22 / $21,767.68
| Facility | | $7,767.63 | $13,606.22 | $21,767.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,037.90 / $13,074.00 / $29,983.91
| Facility | | $8,037.90 | $13,074.00 | $29,983.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,539.86 / $12,830.82 / $18,469.20
| Facility | | $9,539.86 | $12,830.82 | $18,469.20 |