- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,860.00 / $15,837.50 / $25,709.20
| Facility | | $10,860.00 | $15,837.50 | $25,709.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,667.48 / $25,116.96 / $32,201.23
| Facility | | $17,667.48 | $25,116.96 | $32,201.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,752.19 / $24,655.17 / $31,184.33
| Facility | | $12,752.19 | $24,655.17 | $31,184.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,330.60 / $17,032.09 / $27,235.10
| Facility | | $11,330.60 | $17,032.09 | $27,235.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,251.01 / $22,659.39 / $34,426.19
| Facility | | $13,251.01 | $22,659.39 | $34,426.19 |