- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $12,253.50 / $20,012.00
| Facility | | $6,303.00 | $12,253.50 | $20,012.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,184.01 / $22,258.58 / $29,866.20
| Facility | | $16,184.01 | $22,258.58 | $29,866.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,259.97 / $18,209.46 / $25,526.67
| Facility | | $13,259.97 | $18,209.46 | $25,526.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,544.00 / $20,223.65 / $25,495.41
| Facility | | $11,544.00 | $20,223.65 | $25,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,544.00 / $20,392.00 / $26,739.99
| Facility | | $11,544.00 | $20,392.00 | $26,739.99 |