- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $11,055.10 / $18,054.90
| Facility | | $6,303.00 | $11,055.10 | $18,054.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,601.28 / $20,081.77 / $26,945.40
| Facility | | $14,601.28 | $20,081.77 | $26,945.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,963.19 / $16,428.64 / $23,030.26
| Facility | | $11,963.19 | $16,428.64 | $23,030.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,415.04 / $18,245.84 / $23,002.05
| Facility | | $10,415.04 | $18,245.84 | $23,002.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,415.04 / $18,397.73 / $24,124.92
| Facility | | $10,415.04 | $18,397.73 | $24,124.92 |