- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $9,976.01 / $16,642.00
| Facility | | $6,303.00 | $9,976.01 | $16,642.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,176.01 / $18,121.53 / $24,315.19
| Facility | | $13,176.01 | $18,121.53 | $24,315.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,795.43 / $14,825.00 / $20,782.21
| Facility | | $10,795.43 | $14,825.00 | $20,782.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,398.40 / $16,464.82 / $20,756.75
| Facility | | $9,398.40 | $16,464.82 | $20,756.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,398.40 / $16,601.88 / $21,770.02
| Facility | | $9,398.40 | $16,601.88 | $21,770.02 |