- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $9,929.14 / $16,642.00
| Facility | | $6,303.00 | $9,929.14 | $16,642.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,114.10 / $18,036.39 / $24,200.94
| Facility | | $13,114.10 | $18,036.39 | $24,200.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,744.71 / $14,755.34 / $20,684.56
| Facility | | $10,744.71 | $14,755.34 | $20,684.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,354.24 / $16,387.46 / $20,659.23
| Facility | | $9,354.24 | $16,387.46 | $20,659.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,354.24 / $16,523.88 / $21,667.73
| Facility | | $9,354.24 | $16,523.88 | $21,667.73 |