- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $11,978.30 / $19,562.70
| Facility | | $6,303.00 | $11,978.30 | $19,562.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,820.63 / $21,758.80 / $29,195.61
| Facility | | $15,820.63 | $21,758.80 | $29,195.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,962.24 / $17,800.59 / $24,953.51
| Facility | | $12,962.24 | $17,800.59 | $24,953.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,284.80 / $19,769.56 / $24,922.95
| Facility | | $11,284.80 | $19,769.56 | $24,922.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,284.80 / $19,934.13 / $26,139.59
| Facility | | $11,284.80 | $19,934.13 | $26,139.59 |