- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $13,700.50 / $22,375.20
| Facility | | $6,303.00 | $13,700.50 | $22,375.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,095.14 / $24,887.03 / $33,393.01
| Facility | | $18,095.14 | $24,887.03 | $33,393.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,825.80 / $20,359.75 / $28,541.05
| Facility | | $14,825.80 | $20,359.75 | $28,541.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,907.20 / $22,611.80 / $28,506.09
| Facility | | $12,907.20 | $22,611.80 | $28,506.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,907.20 / $22,800.03 / $29,897.65
| Facility | | $12,907.20 | $22,800.03 | $29,897.65 |