- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $8,808.24 / $16,642.00
| Facility | | $6,303.00 | $8,808.24 | $16,642.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,633.65 / $16,000.26 / $21,468.90
| Facility | | $11,633.65 | $16,000.26 | $21,468.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,531.74 / $13,089.61 / $18,349.48
| Facility | | $9,531.74 | $13,089.61 | $18,349.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,298.24 / $14,537.48 / $18,327.00
| Facility | | $8,298.24 | $14,537.48 | $18,327.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,298.24 / $14,658.50 / $19,221.66
| Facility | | $8,298.24 | $14,658.50 | $19,221.66 |