- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,501.00 / $9,480.62 / $15,390.00
| Facility | | $6,501.00 | $9,480.62 | $15,390.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,491.56 / $20,491.56 / $20,491.56
| Facility | | $20,491.56 | $20,491.56 | $20,491.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,908.22 / $16,929.31 / $21,704.24
| Facility | | $11,908.22 | $16,929.31 | $21,704.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,633.70 / $14,759.05 / $18,667.52
| Facility | | $7,633.70 | $14,759.05 | $18,667.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,782.71 / $10,195.70 / $16,303.40
| Facility | | $6,782.71 | $10,195.70 | $16,303.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,932.30 / $13,564.34 / $20,608.16
| Facility | | $7,932.30 | $13,564.34 | $20,608.16 |