- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $11,481.54 / $16,982.44
| Facility | | $8,709.64 | $11,481.54 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $12,882.50 / $13,182.57
| Facility | | $12,882.50 | $12,882.50 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $10,000.00 / $16,982.44
| Facility | | $6,165.95 | $10,000.00 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $13,489.63 / $17,782.79
| Facility | | $8,709.64 | $13,489.63 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $12,882.50 / $19,952.62
| Facility | | $8,317.64 | $12,882.50 | $19,952.62 |