- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,829.24 / $14,283.00 / $21,986.00
| Facility | | $8,829.24 | $14,283.00 | $21,986.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,902.88 / $11,902.88 / $18,421.55
| Facility | | $11,902.88 | $11,902.88 | $18,421.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,028.18 / $12,864.02 / $19,489.27
| Facility | | $8,028.18 | $12,864.02 | $19,489.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,564.00 / $11,616.39 / $19,886.63
| Facility | | $6,564.00 | $11,616.39 | $19,886.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,564.00 / $11,713.08 / $19,342.37
| Facility | | $6,564.00 | $11,713.08 | $19,342.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,487.33 / $14,948.81 / $21,355.72
| Facility | | $6,487.33 | $14,948.81 | $21,355.72 |