- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $9,334.04 / $16,642.00
| Facility | | $6,303.00 | $9,334.04 | $16,642.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,328.11 / $16,955.39 / $22,750.47
| Facility | | $12,328.11 | $16,955.39 | $22,750.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,100.73 / $13,870.99 / $19,444.84
| Facility | | $10,100.73 | $13,870.99 | $19,444.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,793.60 / $14,661.00 / $19,421.03
| Facility | | $8,793.60 | $14,661.00 | $19,421.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,793.60 / $15,533.53 / $20,369.09
| Facility | | $8,793.60 | $15,533.53 | $20,369.09 |