- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $8,571.83 / $16,642.00
| Facility | | $6,303.00 | $8,571.83 | $16,642.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,321.41 / $15,570.82 / $20,892.68
| Facility | | $11,321.41 | $15,570.82 | $20,892.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,275.91 / $12,738.29 / $17,856.99
| Facility | | $9,275.91 | $12,738.29 | $17,856.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,075.52 / $14,147.30 / $17,835.12
| Facility | | $8,075.52 | $14,147.30 | $17,835.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,075.52 / $14,265.07 / $18,705.75
| Facility | | $8,075.52 | $14,265.07 | $18,705.75 |