- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $8,924.40 / $16,642.00
| Facility | | $6,303.00 | $8,924.40 | $16,642.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,787.08 / $16,211.28 / $21,752.03
| Facility | | $11,787.08 | $16,211.28 | $21,752.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,657.45 / $13,262.24 / $18,591.48
| Facility | | $9,657.45 | $13,262.24 | $18,591.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,407.68 / $14,729.20 / $18,568.71
| Facility | | $8,407.68 | $14,729.20 | $18,568.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,407.68 / $14,851.82 / $19,475.16
| Facility | | $8,407.68 | $14,851.82 | $19,475.16 |