- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $9,372.76 / $16,642.00
| Facility | | $6,303.00 | $9,372.76 | $16,642.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,379.26 / $17,025.73 / $22,844.85
| Facility | | $12,379.26 | $17,025.73 | $22,844.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,142.62 / $13,928.53 / $19,525.50
| Facility | | $10,142.62 | $13,928.53 | $19,525.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,830.08 / $15,469.20 / $19,501.59
| Facility | | $8,830.08 | $15,469.20 | $19,501.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,830.08 / $15,597.97 / $20,453.59
| Facility | | $8,830.08 | $15,597.97 | $20,453.59 |