- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,506.70 / $11,918.70 / $16,875.59
| Facility | | $6,506.70 | $11,918.70 | $16,875.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,764.31 / $10,764.31 / $10,764.31
| Facility | | $10,764.31 | $10,764.31 | $10,764.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,071.23 / $11,426.34 / $18,175.71
| Facility | | $7,071.23 | $11,426.34 | $18,175.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,765.00 / $10,721.50 / $19,075.25
| Facility | | $6,765.00 | $10,721.50 | $19,075.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,022.50 / $10,128.29 / $22,556.52
| Facility | | $5,022.50 | $10,128.29 | $22,556.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $9,895.35 / $20,044.90
| Facility | | $3,308.00 | $9,895.35 | $20,044.90 |