- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $9,948.50 / $16,642.00
| Facility | | $6,303.00 | $9,948.50 | $16,642.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,139.67 / $18,071.56 / $24,248.13
| Facility | | $13,139.67 | $18,071.56 | $24,248.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,765.66 / $14,784.11 / $20,724.90
| Facility | | $10,765.66 | $14,784.11 | $20,724.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,372.48 / $16,419.41 / $20,699.50
| Facility | | $9,372.48 | $16,419.41 | $20,699.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,372.48 / $16,556.09 / $21,709.98
| Facility | | $9,372.48 | $16,556.09 | $21,709.98 |