- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $9,978.04 / $16,642.00
| Facility | | $6,303.00 | $9,978.04 | $16,642.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,178.70 / $18,125.24 / $24,320.16
| Facility | | $13,178.70 | $18,125.24 | $24,320.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,797.64 / $14,828.03 / $20,786.46
| Facility | | $10,797.64 | $14,828.03 | $20,786.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,400.32 / $16,468.18 / $20,761.00
| Facility | | $9,400.32 | $16,468.18 | $20,761.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,400.32 / $16,605.27 / $21,774.47
| Facility | | $9,400.32 | $16,605.27 | $21,774.47 |