- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $10,168.60 / $16,642.00
| Facility | | $6,303.00 | $10,168.60 | $16,642.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,430.38 / $18,471.38 / $24,784.60
| Facility | | $13,430.38 | $18,471.38 | $24,784.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,003.84 / $15,111.20 / $21,183.42
| Facility | | $11,003.84 | $15,111.20 | $21,183.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,579.84 / $16,782.68 / $21,157.48
| Facility | | $9,579.84 | $16,782.68 | $21,157.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,779.42 / $14,714.04 / $21,580.59
| Facility | | $9,779.42 | $14,714.04 | $21,580.59 |