- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,604.54 / $11,149.60 / $19,620.00
| Facility | | $6,604.54 | $11,149.60 | $19,620.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,585.73 / $12,781.39 / $21,015.60
| Facility | | $8,585.73 | $12,781.39 | $21,015.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,007.86 / $10,277.16 / $14,794.42
| Facility | | $6,007.86 | $10,277.16 | $14,794.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,191.30 / $19,191.30 / $22,522.62
| Facility | | $19,191.30 | $19,191.30 | $22,522.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $9,716.74 / $13,879.25
| Facility | | $1,787.00 | $9,716.74 | $13,879.25 |