- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $11,000.10 / $17,965.00
| Facility | | $6,303.00 | $11,000.10 | $17,965.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,528.60 / $19,981.81 / $26,811.28
| Facility | | $14,528.60 | $19,981.81 | $26,811.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,903.65 / $16,346.87 / $22,915.63
| Facility | | $11,903.65 | $16,346.87 | $22,915.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,363.20 / $18,155.03 / $22,887.56
| Facility | | $10,363.20 | $18,155.03 | $22,887.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,716.20 / $17,050.70 / $23,345.27
| Facility | | $10,716.20 | $17,050.70 | $23,345.27 |