- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $10,664.90 / $17,417.50
| Facility | | $6,303.00 | $10,664.90 | $17,417.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,085.81 / $19,372.83 / $25,994.15
| Facility | | $14,085.81 | $19,372.83 | $25,994.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,540.86 / $15,848.66 / $22,217.22
| Facility | | $11,540.86 | $15,848.66 | $22,217.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,047.36 / $17,601.72 / $22,190.01
| Facility | | $10,047.36 | $17,601.72 | $22,190.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,256.68 / $15,971.12 / $22,633.77
| Facility | | $10,256.68 | $15,971.12 | $22,633.77 |