- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $9,816.03 / $16,642.00
| Facility | | $6,303.00 | $9,816.03 | $16,642.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,964.71 / $17,830.91 / $23,925.25
| Facility | | $12,964.71 | $17,830.91 | $23,925.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,622.31 / $14,587.25 / $20,448.93
| Facility | | $10,622.31 | $14,587.25 | $20,448.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,247.68 / $16,200.78 / $20,423.89
| Facility | | $9,247.68 | $16,200.78 | $20,423.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,247.68 / $16,335.64 / $21,420.90
| Facility | | $9,247.68 | $16,335.64 | $21,420.90 |