- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $11,040.90 / $18,031.59
| Facility | | $6,303.00 | $11,040.90 | $18,031.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,582.44 / $20,055.86 / $26,910.63
| Facility | | $14,582.44 | $20,055.86 | $26,910.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,947.75 / $16,407.43 / $23,000.54
| Facility | | $11,947.75 | $16,407.43 | $23,000.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,401.60 / $18,222.30 / $22,972.37
| Facility | | $10,401.60 | $18,222.30 | $22,972.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,401.60 / $18,373.99 / $24,093.79
| Facility | | $10,401.60 | $18,373.99 | $24,093.79 |