- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $8,881.60 / $16,642.00
| Facility | | $6,303.00 | $8,881.60 | $16,642.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,730.55 / $16,133.53 / $21,647.72
| Facility | | $11,730.55 | $16,133.53 | $21,647.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,611.12 / $13,198.64 / $18,502.32
| Facility | | $9,611.12 | $13,198.64 | $18,502.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,367.36 / $14,658.57 / $18,479.66
| Facility | | $8,367.36 | $14,658.57 | $18,479.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,367.36 / $14,780.59 / $19,381.77
| Facility | | $8,367.36 | $14,780.59 | $19,381.77 |