- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $11,194.70 / $18,282.90
| Facility | | $6,303.00 | $11,194.70 | $18,282.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,785.66 / $20,335.36 / $27,285.66
| Facility | | $14,785.66 | $20,335.36 | $27,285.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,114.26 / $16,636.09 / $23,321.08
| Facility | | $12,114.26 | $16,636.09 | $23,321.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,546.56 / $18,476.25 / $23,292.52
| Facility | | $10,546.56 | $18,476.25 | $23,292.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,546.56 / $18,630.06 / $24,429.57
| Facility | | $10,546.56 | $18,630.06 | $24,429.57 |