- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,624.00 / $14,904.60 / $16,859.20
| Facility | | $9,624.00 | $14,904.60 | $16,859.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,092.00 / $13,286.90 / $18,421.05
| Facility | | $3,092.00 | $13,286.90 | $18,421.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,784.00 / $12,241.54 / $17,038.06
| Facility | | $5,784.00 | $12,241.54 | $17,038.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,596.00 / $16,066.00 / $25,651.00
| Facility | | $10,596.00 | $16,066.00 | $25,651.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,274.00 / $17,346.75 / $22,915.48
| Facility | | $5,274.00 | $17,346.75 | $22,915.48 |