- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,357.55 / $11,418.00 / $18,278.50
| Facility | | $7,357.55 | $11,418.00 | $18,278.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,007.34 / $12,007.34 / $12,007.34
| Facility | | $12,007.34 | $12,007.34 | $12,007.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,580.43 / $8,910.45 / $12,644.96
| Facility | | $4,580.43 | $8,910.45 | $12,644.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,798.88 / $9,108.49 / $15,959.29
| Facility | | $6,798.88 | $9,108.49 | $15,959.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,675.95 / $10,315.45 / $13,823.02
| Facility | | $6,675.95 | $10,315.45 | $13,823.02 |