- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $10,332.70 / $16,875.00
| Facility | | $6,303.00 | $10,332.70 | $16,875.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,647.06 / $18,769.39 / $25,184.47
| Facility | | $13,647.06 | $18,769.39 | $25,184.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,181.38 / $15,355.00 / $21,525.19
| Facility | | $11,181.38 | $15,355.00 | $21,525.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,734.40 / $17,053.45 / $21,498.83
| Facility | | $9,734.40 | $17,053.45 | $21,498.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,734.40 / $17,195.41 / $22,548.32
| Facility | | $9,734.40 | $17,195.41 | $22,548.32 |