- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,727.94 / $11,561.40 / $20,228.00
| Facility | | $8,727.94 | $11,561.40 | $20,228.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,807.72 / $10,807.72 / $10,807.72
| Facility | | $10,807.72 | $10,807.72 | $10,807.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,843.91 / $10,441.02 / $19,562.00
| Facility | | $5,843.91 | $10,441.02 | $19,562.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,366.74 / $12,426.79 / $18,060.08
| Facility | | $8,366.74 | $12,426.79 | $18,060.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $11,914.54 / $18,197.99
| Facility | | $3,496.00 | $11,914.54 | $18,197.99 |