- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,058.00 / $17,830.80 / $23,927.50
| Facility | | $9,058.00 | $17,830.80 | $23,927.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,787.87 / $9,787.87 / $19,536.28
| Facility | | $9,787.87 | $9,787.87 | $19,536.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,840.00 / $14,430.05 / $21,832.91
| Facility | | $6,840.00 | $14,430.05 | $21,832.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,826.37 / $14,356.50 / $32,925.19
| Facility | | $8,826.37 | $14,356.50 | $32,925.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,850.00 / $13,122.80 / $19,046.29
| Facility | | $7,850.00 | $13,122.80 | $19,046.29 |