- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $12,644.80 / $20,651.09
| Facility | | $6,303.00 | $12,644.80 | $20,651.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,700.83 / $22,969.37 / $30,819.94
| Facility | | $16,700.83 | $22,969.37 | $30,819.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,683.40 / $18,790.95 / $26,341.83
| Facility | | $13,683.40 | $18,790.95 | $26,341.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,912.64 / $20,869.46 / $26,309.56
| Facility | | $11,912.64 | $20,869.46 | $26,309.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,912.64 / $21,043.18 / $27,593.89
| Facility | | $11,912.64 | $21,043.18 | $27,593.89 |