- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,151.70 / $13,026.40 / $21,626.80
| Facility | | $10,151.70 | $13,026.40 | $21,626.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,944.15 / $9,944.15 / $9,944.15
| Facility | | $9,944.15 | $9,944.15 | $9,944.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,613.07 / $13,185.24 / $22,285.00
| Facility | | $8,613.07 | $13,185.24 | $22,285.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,661.00 / $13,267.58 / $21,911.00
| Facility | | $9,661.00 | $13,267.58 | $21,911.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,787.00 / $13,948.83 / $22,360.57
| Facility | | $8,787.00 | $13,948.83 | $22,360.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,980.00 / $13,651.76 / $20,523.00
| Facility | | $6,980.00 | $13,651.76 | $20,523.00 |