- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $9,739.60 / $16,642.00
| Facility | | $6,303.00 | $9,739.60 | $16,642.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,863.77 / $17,692.09 / $23,738.98
| Facility | | $12,863.77 | $17,692.09 | $23,738.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,539.61 / $14,473.68 / $20,289.72
| Facility | | $10,539.61 | $14,473.68 | $20,289.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,175.68 / $15,600.00 / $20,264.87
| Facility | | $9,175.68 | $15,600.00 | $20,264.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,175.68 / $16,208.46 / $21,254.12
| Facility | | $9,175.68 | $16,208.46 | $21,254.12 |