- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,321.70 / $10,760.30 / $16,613.00
| Facility | | $7,321.70 | $10,760.30 | $16,613.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,587.72 / $23,581.92 / $30,233.23
| Facility | | $16,587.72 | $23,581.92 | $30,233.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,855.40 / $15,348.66 / $20,150.93
| Facility | | $6,855.40 | $15,348.66 | $20,150.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,321.70 / $11,005.90 / $17,599.00
| Facility | | $7,321.70 | $11,005.90 | $17,599.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,562.64 / $14,642.22 / $22,245.79
| Facility | | $8,562.64 | $14,642.22 | $22,245.79 |