- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $9,305.51 / $16,642.00
| Facility | | $6,303.00 | $9,305.51 | $16,642.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,290.43 / $16,903.56 / $22,680.93
| Facility | | $12,290.43 | $16,903.56 | $22,680.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,069.86 / $13,828.59 / $19,385.41
| Facility | | $10,069.86 | $13,828.59 | $19,385.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,766.71 / $15,358.20 / $19,361.66
| Facility | | $8,766.71 | $15,358.20 | $19,361.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,766.71 / $15,486.05 / $20,306.83
| Facility | | $8,766.71 | $15,486.05 | $20,306.83 |