- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $9,836.41 / $16,642.00
| Facility | | $6,303.00 | $9,836.41 | $16,642.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,991.63 / $17,867.93 / $23,974.92
| Facility | | $12,991.63 | $17,867.93 | $23,974.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,644.36 / $14,617.54 / $20,491.39
| Facility | | $10,644.36 | $14,617.54 | $20,491.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,266.87 / $16,234.42 / $20,466.29
| Facility | | $9,266.87 | $16,234.42 | $20,466.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,266.87 / $16,369.56 / $21,465.38
| Facility | | $9,266.87 | $16,369.56 | $21,465.38 |