- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $8,695.12 / $16,642.00
| Facility | | $6,303.00 | $8,695.12 | $16,642.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,484.26 / $15,794.80 / $21,193.21
| Facility | | $11,484.26 | $15,794.80 | $21,193.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,409.34 / $12,921.52 / $18,113.84
| Facility | | $9,409.34 | $12,921.52 | $18,113.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,191.68 / $14,350.80 / $18,091.66
| Facility | | $8,191.68 | $14,350.80 | $18,091.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,191.68 / $14,470.26 / $18,974.83
| Facility | | $8,191.68 | $14,470.26 | $18,974.83 |