- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $9,945.44 / $16,642.00
| Facility | | $6,303.00 | $9,945.44 | $16,642.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,135.63 / $18,066.00 / $24,240.68
| Facility | | $13,135.63 | $18,066.00 | $24,240.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,762.35 / $14,779.57 / $20,718.53
| Facility | | $10,762.35 | $14,779.57 | $20,718.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,369.60 / $16,414.37 / $20,693.15
| Facility | | $9,369.60 | $16,414.37 | $20,693.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,369.60 / $16,551.00 / $21,703.31
| Facility | | $9,369.60 | $16,551.00 | $21,703.31 |