- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,169.28 / $13,551.50 / $18,185.00
| Facility | | $8,169.28 | $13,551.50 | $18,185.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,295.01 / $11,295.01 / $11,295.01
| Facility | | $11,295.01 | $11,295.01 | $11,295.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,745.49 / $11,525.15 / $18,122.66
| Facility | | $6,745.49 | $11,525.15 | $18,122.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,708.08 / $10,911.00 / $25,023.29
| Facility | | $6,708.08 | $10,911.00 | $25,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,964.30 / $10,558.21 / $15,098.64
| Facility | | $7,964.30 | $10,558.21 | $15,098.64 |