- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,120.75 / $10,465.00 / $16,157.10
| Facility | | $7,120.75 | $10,465.00 | $16,157.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,688.39 / $23,725.03 / $30,416.71
| Facility | | $16,688.39 | $23,725.03 | $30,416.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,014.15 / $15,494.62 / $19,597.89
| Facility | | $8,014.15 | $15,494.62 | $19,597.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,120.75 / $10,703.90 / $17,116.00
| Facility | | $7,120.75 | $10,703.90 | $17,116.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,327.64 / $14,240.36 / $21,635.25
| Facility | | $8,327.64 | $14,240.36 | $21,635.25 |