- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $8,760.34 / $16,642.00
| Facility | | $6,303.00 | $8,760.34 | $16,642.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,570.39 / $15,913.26 / $21,352.16
| Facility | | $11,570.39 | $15,913.26 | $21,352.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,479.91 / $13,018.44 / $18,249.71
| Facility | | $9,479.91 | $13,018.44 | $18,249.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,253.12 / $14,458.43 / $18,227.36
| Facility | | $8,253.12 | $14,458.43 | $18,227.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,253.12 / $14,578.79 / $19,117.15
| Facility | | $8,253.12 | $14,578.79 | $19,117.15 |