- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,300.00 / $11,716.90 / $17,861.80
| Facility | | $6,300.00 | $11,716.90 | $17,861.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,138.28 / $11,516.21 / $18,139.43
| Facility | | $7,138.28 | $11,516.21 | $18,139.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,160.34 / $11,348.05 / $20,189.99
| Facility | | $7,160.34 | $11,348.05 | $20,189.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,264.00 / $10,473.62 / $23,874.70
| Facility | | $5,264.00 | $10,473.62 | $23,874.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $10,473.62 / $21,216.30
| Facility | | $3,308.00 | $10,473.62 | $21,216.30 |