- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $9,958.69 / $16,642.00
| Facility | | $6,303.00 | $9,958.69 | $16,642.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,153.13 / $18,090.07 / $24,272.97
| Facility | | $13,153.13 | $18,090.07 | $24,272.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,776.69 / $14,799.25 / $20,746.12
| Facility | | $10,776.69 | $14,799.25 | $20,746.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,382.08 / $16,436.23 / $20,720.71
| Facility | | $9,382.08 | $16,436.23 | $20,720.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,382.08 / $16,573.05 / $21,732.22
| Facility | | $9,382.08 | $16,573.05 | $21,732.22 |