- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,900.00 / $15,047.90 / $18,170.00
| Facility | | $7,900.00 | $15,047.90 | $18,170.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,916.00 / $13,588.00 / $23,323.96
| Facility | | $6,916.00 | $13,588.00 | $23,323.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,656.72 / $13,288.48 / $16,954.30
| Facility | | $11,656.72 | $13,288.48 | $16,954.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,045.21 / $11,569.25 / $14,556.26
| Facility | | $8,045.21 | $11,569.25 | $14,556.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,373.89 / $15,064.82 / $23,167.36
| Facility | | $8,373.89 | $15,064.82 | $23,167.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,182.15 / $12,893.25 / $18,055.14
| Facility | | $9,182.15 | $12,893.25 | $18,055.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,775.00 / $12,389.73 / $17,847.68
| Facility | | $3,775.00 | $12,389.73 | $17,847.68 |