- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $8,520.87 / $16,642.00
| Facility | | $6,303.00 | $8,520.87 | $16,642.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,254.11 / $15,478.27 / $20,768.50
| Facility | | $11,254.11 | $15,478.27 | $20,768.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,220.78 / $12,662.58 / $17,750.84
| Facility | | $9,220.78 | $12,662.58 | $17,750.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,027.52 / $14,063.21 / $17,729.11
| Facility | | $8,027.52 | $14,063.21 | $17,729.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,027.52 / $14,180.28 / $18,594.58
| Facility | | $8,027.52 | $14,180.28 | $18,594.58 |