- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,369.00 / $10,912.50 / $17,821.90
| Facility | | $2,369.00 | $10,912.50 | $17,821.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,043.74 / $19,059.88 / $26,597.69
| Facility | | $14,043.74 | $19,059.88 | $26,597.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,808.81 / $15,608.37 / $22,733.07
| Facility | | $11,808.81 | $15,608.37 | $22,733.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,280.64 / $18,010.40 / $22,705.22
| Facility | | $10,280.64 | $18,010.40 | $22,705.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,280.64 / $18,160.32 / $23,813.60
| Facility | | $10,280.64 | $18,160.32 | $23,813.60 |