- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,369.00 / $9,784.44 / $16,642.00
| Facility | | $2,369.00 | $9,784.44 | $16,642.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,592.02 / $17,089.64 / $22,542.83
| Facility | | $12,592.02 | $17,089.64 | $22,542.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,588.13 / $13,534.02 / $20,383.13
| Facility | | $10,588.13 | $13,534.02 | $20,383.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,217.92 / $16,148.64 / $20,358.16
| Facility | | $9,217.92 | $16,148.64 | $20,358.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,217.92 / $16,283.07 / $21,351.97
| Facility | | $9,217.92 | $16,283.07 | $21,351.97 |