- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,206.00 / $16,248.00 / $32,566.00
| Facility | | $4,206.00 | $16,248.00 | $32,566.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,258.00 / $15,346.78 / $20,492.36
| Facility | | $11,258.00 | $15,346.78 | $20,492.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,027.32 / $15,919.13 / $25,113.96
| Facility | | $10,027.32 | $15,919.13 | $25,113.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,520.25 / $13,879.25 / $25,357.17
| Facility | | $7,520.25 | $13,879.25 | $25,357.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,505.00 / $17,082.30 / $22,896.24
| Facility | | $6,505.00 | $17,082.30 | $22,896.24 |