- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $11,380.20 / $18,585.80
| Facility | | $6,303.00 | $11,380.20 | $18,585.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,030.61 / $20,672.25 / $27,737.69
| Facility | | $15,030.61 | $20,672.25 | $27,737.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,314.95 / $16,911.70 / $23,707.43
| Facility | | $12,314.95 | $16,911.70 | $23,707.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,721.28 / $18,782.34 / $23,678.39
| Facility | | $10,721.28 | $18,782.34 | $23,678.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,721.28 / $18,938.68 / $24,834.28
| Facility | | $10,721.28 | $18,938.68 | $24,834.28 |