- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,630.00 / $18,145.00 / $29,493.30
| Facility | | $10,630.00 | $18,145.00 | $29,493.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,258.00 / $17,221.25 / $21,768.88
| Facility | | $11,258.00 | $17,221.25 | $21,768.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,170.03 / $14,417.14 / $22,744.43
| Facility | | $9,170.03 | $14,417.14 | $22,744.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,101.78 / $12,209.29 / $22,938.57
| Facility | | $6,101.78 | $12,209.29 | $22,938.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,626.54 / $16,408.20 / $21,840.74
| Facility | | $10,626.54 | $16,408.20 | $21,840.74 |