- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,443.22 / $11,802.40 / $16,711.00
| Facility | | $6,443.22 | $11,802.40 | $16,711.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,353.27 / $8,353.27 / $10,478.16
| Facility | | $8,353.27 | $8,353.27 | $10,478.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,275.27 / $11,799.29 / $18,977.23
| Facility | | $7,275.27 | $11,799.29 | $18,977.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,699.00 / $10,616.90 / $18,889.15
| Facility | | $6,699.00 | $10,616.90 | $18,889.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,973.50 / $10,017.04 / $22,336.46
| Facility | | $4,973.50 | $10,017.04 | $22,336.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,973.50 / $10,609.73 / $22,336.46
| Facility | | $4,973.50 | $10,609.73 | $22,336.46 |