- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,156.00 / $8,977.50 / $14,573.30
| Facility | | $6,156.00 | $8,977.50 | $14,573.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,476.51 / $17,737.22 / $22,740.03
| Facility | | $12,476.51 | $17,737.22 | $22,740.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,228.59 / $13,975.80 / $17,676.86
| Facility | | $7,228.59 | $13,975.80 | $17,676.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,422.76 / $9,654.66 / $15,438.20
| Facility | | $6,422.76 | $9,654.66 | $15,438.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,453.20 / $12,844.49 / $19,514.52
| Facility | | $8,453.20 | $12,844.49 | $19,514.52 |