- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $8,907.08 / $16,642.00
| Facility | | $6,303.00 | $8,907.08 | $16,642.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,764.20 / $16,179.81 / $21,709.81
| Facility | | $11,764.20 | $16,179.81 | $21,709.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,638.70 / $13,236.50 / $18,555.39
| Facility | | $9,638.70 | $13,236.50 | $18,555.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,391.36 / $14,700.61 / $18,532.66
| Facility | | $8,391.36 | $14,700.61 | $18,532.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,391.36 / $14,822.99 / $19,437.36
| Facility | | $8,391.36 | $14,822.99 | $19,437.36 |