- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $9,365.62 / $16,642.00
| Facility | | $6,303.00 | $9,365.62 | $16,642.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,369.84 / $17,012.77 / $22,827.47
| Facility | | $12,369.84 | $17,012.77 | $22,827.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,134.92 / $13,917.93 / $19,510.65
| Facility | | $10,134.92 | $13,917.93 | $19,510.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,823.36 / $15,457.42 / $19,486.75
| Facility | | $8,823.36 | $15,457.42 | $19,486.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,823.36 / $15,586.10 / $20,438.03
| Facility | | $8,823.36 | $15,586.10 | $20,438.03 |