- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,447.35 / $15,671.60 / $21,030.00
| Facility | | $9,447.35 | $15,671.60 | $21,030.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,713.68 / $11,523.97 / $15,128.69
| Facility | | $8,713.68 | $11,523.97 | $15,128.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,668.68 / $13,432.88 / $21,490.37
| Facility | | $7,668.68 | $13,432.88 | $21,490.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,757.55 / $12,618.00 / $28,938.12
| Facility | | $7,757.55 | $12,618.00 | $28,938.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,210.29 / $12,429.57 / $17,608.00
| Facility | | $9,210.29 | $12,429.57 | $17,608.00 |