- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $10,677.10 / $17,437.50
| Facility | | $6,303.00 | $10,677.10 | $17,437.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,101.96 / $19,395.04 / $26,023.96
| Facility | | $14,101.96 | $19,395.04 | $26,023.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,554.09 / $15,866.84 / $22,242.70
| Facility | | $11,554.09 | $15,866.84 | $22,242.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,058.87 / $17,621.90 / $22,215.46
| Facility | | $10,058.87 | $17,621.90 | $22,215.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,058.87 / $17,768.59 / $23,299.93
| Facility | | $10,058.87 | $17,768.59 | $23,299.93 |