- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $11,287.50 / $18,434.30
| Facility | | $6,303.00 | $11,287.50 | $18,434.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,908.14 / $20,503.80 / $27,511.68
| Facility | | $14,908.14 | $20,503.80 | $27,511.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,214.61 / $16,773.90 / $23,514.26
| Facility | | $12,214.61 | $16,773.90 | $23,514.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,633.92 / $18,629.30 / $23,485.46
| Facility | | $10,633.92 | $18,629.30 | $23,485.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,633.92 / $18,784.38 / $24,631.92
| Facility | | $10,633.92 | $18,784.38 | $24,631.92 |