- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $8,048.06 / $16,642.00
| Facility | | $6,303.00 | $8,048.06 | $16,642.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,629.63 / $14,619.40 / $19,616.07
| Facility | | $10,629.63 | $14,619.40 | $19,616.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.12 / $11,959.94 / $16,765.87
| Facility | | $8,709.12 | $11,959.94 | $16,765.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,582.08 / $13,282.86 / $16,745.34
| Facility | | $7,582.08 | $13,282.86 | $16,745.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,582.08 / $13,393.43 / $17,562.78
| Facility | | $7,582.08 | $13,393.43 | $17,562.78 |