- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $9,671.33 / $16,642.00
| Facility | | $6,303.00 | $9,671.33 | $16,642.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,773.60 / $17,568.08 / $23,572.57
| Facility | | $12,773.60 | $17,568.08 | $23,572.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,465.73 / $14,372.22 / $20,147.49
| Facility | | $10,465.73 | $14,372.22 | $20,147.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,111.36 / $15,961.96 / $20,122.82
| Facility | | $9,111.36 | $15,961.96 | $20,122.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,111.36 / $16,094.84 / $21,105.14
| Facility | | $9,111.36 | $16,094.84 | $21,105.14 |