- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $8,710.41 / $16,642.00
| Facility | | $6,303.00 | $8,710.41 | $16,642.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,504.45 / $15,822.56 / $21,230.46
| Facility | | $11,504.45 | $15,822.56 | $21,230.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,425.87 / $12,944.24 / $18,145.68
| Facility | | $9,425.87 | $12,944.24 | $18,145.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,206.08 / $14,376.03 / $18,123.47
| Facility | | $8,206.08 | $14,376.03 | $18,123.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,206.08 / $14,495.70 / $19,008.18
| Facility | | $8,206.08 | $14,495.70 | $19,008.18 |