- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $13,274.50 / $21,679.50
| Facility | | $6,303.00 | $13,274.50 | $21,679.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,532.57 / $24,113.30 / $32,354.85
| Facility | | $17,532.57 | $24,113.30 | $32,354.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,364.87 / $19,726.79 / $27,653.72
| Facility | | $14,364.87 | $19,726.79 | $27,653.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,505.92 / $20,576.15 / $27,619.85
| Facility | | $12,505.92 | $20,576.15 | $27,619.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,505.92 / $22,091.19 / $28,968.14
| Facility | | $12,505.92 | $22,091.19 | $28,968.14 |