- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $11,422.00 / $18,654.00
| Facility | | $6,303.00 | $11,422.00 | $18,654.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,085.79 / $20,748.14 / $27,839.52
| Facility | | $15,085.79 | $20,748.14 | $27,839.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,360.16 / $16,973.79 / $23,794.47
| Facility | | $12,360.16 | $16,973.79 | $23,794.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,760.64 / $18,851.30 / $23,765.32
| Facility | | $10,760.64 | $18,851.30 | $23,765.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,760.64 / $19,008.22 / $24,925.45
| Facility | | $10,760.64 | $19,008.22 | $24,925.45 |