- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,745.60 / $14,148.00 / $19,549.90
| Facility | | $8,745.60 | $14,148.00 | $19,549.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,103.48 / $14,836.83 / $15,606.90
| Facility | | $13,103.48 | $14,836.83 | $15,606.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,142.18 / $13,046.69 / $19,766.02
| Facility | | $8,142.18 | $13,046.69 | $19,766.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,564.00 / $11,820.13 / $19,704.53
| Facility | | $6,564.00 | $11,820.13 | $19,704.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,564.00 / $11,861.91 / $17,963.20
| Facility | | $6,564.00 | $11,861.91 | $17,963.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,806.98 / $15,153.11 / $21,024.76
| Facility | | $7,806.98 | $15,153.11 | $21,024.76 |