- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,566.40 / $9,576.00 / $15,544.90
| Facility | | $6,566.40 | $9,576.00 | $15,544.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,647.66 / $11,647.66 / $13,749.56
| Facility | | $11,647.66 | $11,647.66 | $13,749.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,798.00 / $18,194.27 / $23,325.99
| Facility | | $12,798.00 | $18,194.27 | $23,325.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,710.50 / $14,907.52 / $18,855.32
| Facility | | $7,710.50 | $14,907.52 | $18,855.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,850.94 / $10,298.29 / $16,467.40
| Facility | | $6,850.94 | $10,298.29 | $16,467.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,012.10 / $13,700.79 / $20,815.49
| Facility | | $8,012.10 | $13,700.79 | $20,815.49 |