- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,219.77 / $14,030.80 / $22,806.00
| Facility | | $8,219.77 | $14,030.80 | $22,806.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,177.00 / $11,258.00 / $17,045.06
| Facility | | $11,177.00 | $11,258.00 | $17,045.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,048.40 / $11,148.19 / $17,587.34
| Facility | | $7,048.40 | $11,148.19 | $17,587.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,294.42 / $10,980.57 / $20,705.03
| Facility | | $6,294.42 | $10,980.57 | $20,705.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,164.00 / $11,806.58 / $16,034.28
| Facility | | $6,164.00 | $11,806.58 | $16,034.28 |