- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.90 / $11,744.40 / $15,760.00
| Facility | | $7,079.90 | $11,744.40 | $15,760.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,065.02 / $8,065.02 / $8,065.02
| Facility | | $8,065.02 | $8,065.02 | $8,065.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,785.55 / $10,115.87 / $15,906.67
| Facility | | $5,785.55 | $10,115.87 | $15,906.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,813.55 / $9,456.00 / $21,686.39
| Facility | | $5,813.55 | $9,456.00 | $21,686.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,902.25 / $9,314.79 / $13,195.53
| Facility | | $6,902.25 | $9,314.79 | $13,195.53 |