- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $9,023.25 / $16,642.00
| Facility | | $6,303.00 | $9,023.25 | $16,642.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,917.63 / $16,390.83 / $21,992.95
| Facility | | $11,917.63 | $16,390.83 | $21,992.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,764.41 / $13,409.13 / $18,797.39
| Facility | | $9,764.41 | $13,409.13 | $18,797.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,500.79 / $14,395.00 / $18,774.37
| Facility | | $8,500.79 | $14,395.00 | $18,774.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,500.79 / $15,016.31 / $19,690.86
| Facility | | $8,500.79 | $15,016.31 | $19,690.86 |