- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,222.62 / $11,171.10 / $16,900.00
| Facility | | $8,222.62 | $11,171.10 | $16,900.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,979.77 / $11,979.77 / $11,979.77
| Facility | | $11,979.77 | $11,979.77 | $11,979.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,616.82 / $10,387.37 / $15,593.26
| Facility | | $6,616.82 | $10,387.37 | $15,593.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,173.18 / $9,903.01 / $17,924.00
| Facility | | $7,173.18 | $9,903.01 | $17,924.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $76.25 / $105.51 / $177.85
| Facility | | $76.25 | $105.51 | $177.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,900.90 / $10,934.54 / $17,995.70
| Facility | | $7,900.90 | $10,934.54 | $17,995.70 |