- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $12,268.80 / $20,037.00
| Facility | | $6,303.00 | $12,268.80 | $20,037.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,204.20 / $22,286.34 / $29,903.46
| Facility | | $16,204.20 | $22,286.34 | $29,903.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,276.51 / $18,232.16 / $25,558.51
| Facility | | $13,276.51 | $18,232.16 | $25,558.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,558.40 / $20,248.87 / $25,527.21
| Facility | | $11,558.40 | $20,248.87 | $25,527.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,558.40 / $20,417.43 / $26,773.35
| Facility | | $11,558.40 | $20,417.43 | $26,773.35 |