- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,426.24 / $10,914.00 / $16,850.20
| Facility | | $7,426.24 | $10,914.00 | $16,850.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,948.60 / $12,948.60 / $12,948.60
| Facility | | $12,948.60 | $12,948.60 | $12,948.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,276.40 / $14,609.43 / $18,730.04
| Facility | | $10,276.40 | $14,609.43 | $18,730.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,357.96 / $16,159.35 / $20,438.66
| Facility | | $8,357.96 | $16,159.35 | $20,438.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,426.24 / $11,163.10 / $17,850.30
| Facility | | $7,426.24 | $11,163.10 | $17,850.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,684.90 / $14,851.29 / $22,563.43
| Facility | | $8,684.90 | $14,851.29 | $22,563.43 |