- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $10,877.80 / $17,765.30
| Facility | | $6,303.00 | $10,877.80 | $17,765.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,367.10 / $19,759.68 / $26,513.24
| Facility | | $14,367.10 | $19,759.68 | $26,513.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,771.32 / $16,165.15 / $22,660.89
| Facility | | $11,771.32 | $16,165.15 | $22,660.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,248.00 / $17,953.22 / $22,633.14
| Facility | | $10,248.00 | $17,953.22 | $22,633.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,248.00 / $18,102.66 / $23,738.00
| Facility | | $10,248.00 | $18,102.66 | $23,738.00 |