- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $13,202.20 / $21,561.40
| Facility | | $6,303.00 | $13,202.20 | $21,561.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,437.00 / $23,981.88 / $32,178.51
| Facility | | $17,437.00 | $23,981.88 | $32,178.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,286.58 / $19,619.27 / $27,503.00
| Facility | | $14,286.58 | $19,619.27 | $27,503.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,437.76 / $21,789.40 / $27,469.31
| Facility | | $12,437.76 | $21,789.40 | $27,469.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,437.76 / $21,970.78 / $28,810.26
| Facility | | $12,437.76 | $21,970.78 | $28,810.26 |