- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $9,473.64 / $16,642.00
| Facility | | $6,303.00 | $9,473.64 | $16,642.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,512.50 / $17,208.98 / $23,090.74
| Facility | | $12,512.50 | $17,208.98 | $23,090.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,251.79 / $14,078.45 / $19,735.66
| Facility | | $10,251.79 | $14,078.45 | $19,735.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,925.12 / $15,635.69 / $19,711.50
| Facility | | $8,925.12 | $15,635.69 | $19,711.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,925.12 / $15,765.85 / $20,673.74
| Facility | | $8,925.12 | $15,765.85 | $20,673.74 |