- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $9,418.62 / $16,642.00
| Facility | | $6,303.00 | $9,418.62 | $16,642.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,439.82 / $17,109.02 / $22,956.62
| Facility | | $12,439.82 | $17,109.02 | $22,956.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,192.26 / $13,996.67 / $19,621.04
| Facility | | $10,192.26 | $13,996.67 | $19,621.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,873.28 / $15,544.88 / $19,597.00
| Facility | | $8,873.28 | $15,544.88 | $19,597.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,873.28 / $15,674.28 / $20,553.66
| Facility | | $8,873.28 | $15,674.28 | $20,553.66 |