- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $9,339.12 / $16,642.00
| Facility | | $6,303.00 | $9,339.12 | $16,642.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,334.84 / $16,964.64 / $22,762.89
| Facility | | $12,334.84 | $16,964.64 | $22,762.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,106.25 / $13,878.56 / $19,455.46
| Facility | | $10,106.25 | $13,878.56 | $19,455.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,798.40 / $15,413.70 / $19,431.63
| Facility | | $8,798.40 | $15,413.70 | $19,431.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,798.40 / $15,542.01 / $20,380.21
| Facility | | $8,798.40 | $15,542.01 | $20,380.21 |