- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,104.15 / $13,443.40 / $18,040.00
| Facility | | $8,104.15 | $13,443.40 | $18,040.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,280.54 / $10,280.54 / $12,569.74
| Facility | | $10,280.54 | $10,280.54 | $12,569.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,950.07 / $11,874.69 / $18,672.29
| Facility | | $6,950.07 | $11,874.69 | $18,672.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,654.60 / $10,824.00 / $24,823.76
| Facility | | $6,654.60 | $10,824.00 | $24,823.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,900.80 / $10,662.36 / $15,104.53
| Facility | | $7,900.80 | $10,662.36 | $15,104.53 |