- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $11,823.50 / $19,309.70
| Facility | | $6,303.00 | $11,823.50 | $19,309.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,616.06 / $21,477.44 / $28,818.09
| Facility | | $15,616.06 | $21,477.44 | $28,818.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,794.63 / $17,570.41 / $24,630.85
| Facility | | $12,794.63 | $17,570.41 | $24,630.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,138.88 / $19,513.93 / $24,600.68
| Facility | | $11,138.88 | $19,513.93 | $24,600.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,138.88 / $19,676.37 / $25,801.59
| Facility | | $11,138.88 | $19,676.37 | $25,801.59 |