- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $10,843.20 / $17,708.80
| Facility | | $6,303.00 | $10,843.20 | $17,708.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,321.34 / $19,696.75 / $26,428.80
| Facility | | $14,321.34 | $19,696.75 | $26,428.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,733.83 / $16,113.67 / $22,588.71
| Facility | | $11,733.83 | $16,113.67 | $22,588.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,215.36 / $17,600.00 / $22,561.05
| Facility | | $10,215.36 | $17,600.00 | $22,561.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,215.36 / $18,045.00 / $23,662.39
| Facility | | $10,215.36 | $18,045.00 | $23,662.39 |