- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $14,304.70 / $23,362.00
| Facility | | $6,303.00 | $14,304.70 | $23,362.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,893.24 / $25,984.69 / $34,865.83
| Facility | | $18,893.24 | $25,984.69 | $34,865.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,479.70 / $21,257.74 / $29,799.87
| Facility | | $15,479.70 | $21,257.74 | $29,799.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,476.48 / $23,609.11 / $29,763.37
| Facility | | $13,476.48 | $23,609.11 | $29,763.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,476.48 / $23,805.64 / $31,216.30
| Facility | | $13,476.48 | $23,805.64 | $31,216.30 |