- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $9,356.45 / $16,642.00
| Facility | | $6,303.00 | $9,356.45 | $16,642.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,357.72 / $16,996.11 / $22,805.11
| Facility | | $12,357.72 | $16,996.11 | $22,805.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,124.99 / $13,904.30 / $19,491.55
| Facility | | $10,124.99 | $13,904.30 | $19,491.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,814.71 / $15,442.29 / $19,467.68
| Facility | | $8,814.71 | $15,442.29 | $19,467.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,814.71 / $15,570.84 / $20,418.00
| Facility | | $8,814.71 | $15,570.84 | $20,418.00 |