- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $9,126.16 / $16,642.00
| Facility | | $6,303.00 | $9,126.16 | $16,642.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,053.56 / $16,577.78 / $22,243.80
| Facility | | $12,053.56 | $16,577.78 | $22,243.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,875.78 / $13,562.07 / $19,011.80
| Facility | | $9,875.78 | $13,562.07 | $19,011.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,597.76 / $15,062.20 / $18,988.50
| Facility | | $8,597.76 | $15,062.20 | $18,988.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,597.76 / $15,187.58 / $19,915.46
| Facility | | $8,597.76 | $15,187.58 | $19,915.46 |