- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,930.22 / $10,662.50 / $21,024.00
| Facility | | $6,930.22 | $10,662.50 | $21,024.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,443.11 / $9,863.37 / $16,350.96
| Facility | | $6,443.11 | $9,863.37 | $16,350.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,408.75 / $11,361.12 / $16,335.91
| Facility | | $8,408.75 | $11,361.12 | $16,335.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,707.50 / $11,405.87 / $28,811.04
| Facility | | $5,707.50 | $11,405.87 | $28,811.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,707.50 / $10,889.91 / $15,305.23
| Facility | | $5,707.50 | $10,889.91 | $15,305.23 |