- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $10,913.50 / $17,823.59
| Facility | | $6,303.00 | $10,913.50 | $17,823.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,414.20 / $19,824.48 / $26,600.17
| Facility | | $14,414.20 | $19,824.48 | $26,600.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,809.92 / $16,218.15 / $22,735.19
| Facility | | $11,809.92 | $16,218.15 | $22,735.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,281.60 / $18,012.08 / $22,707.34
| Facility | | $10,281.60 | $18,012.08 | $22,707.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,281.60 / $18,162.02 / $23,815.83
| Facility | | $10,281.60 | $18,162.02 | $23,815.83 |