- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $10,788.20 / $17,618.90
| Facility | | $6,303.00 | $10,788.20 | $17,618.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,248.66 / $19,596.80 / $26,294.68
| Facility | | $14,248.66 | $19,596.80 | $26,294.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,674.28 / $16,031.89 / $22,474.08
| Facility | | $11,674.28 | $16,031.89 | $22,474.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,163.52 / $17,805.22 / $22,446.56
| Facility | | $10,163.52 | $17,805.22 | $22,446.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,163.52 / $17,953.43 / $23,542.31
| Facility | | $10,163.52 | $17,953.43 | $23,542.31 |