- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $9,270.86 / $16,642.00
| Facility | | $6,303.00 | $9,270.86 | $16,642.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,244.67 / $16,840.63 / $22,596.48
| Facility | | $12,244.67 | $16,840.63 | $22,596.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,032.36 / $13,777.10 / $19,313.23
| Facility | | $10,032.36 | $13,777.10 | $19,313.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,734.08 / $15,301.02 / $19,289.58
| Facility | | $8,734.08 | $15,301.02 | $19,289.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,734.08 / $15,428.39 / $20,231.22
| Facility | | $8,734.08 | $15,428.39 | $20,231.22 |