- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $13,774.80 / $22,496.70
| Facility | | $6,303.00 | $13,774.80 | $22,496.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,193.39 / $25,022.16 / $33,574.33
| Facility | | $18,193.39 | $25,022.16 | $33,574.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,906.30 / $20,470.31 / $28,696.01
| Facility | | $14,906.30 | $20,470.31 | $28,696.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,977.28 / $22,734.57 / $28,660.86
| Facility | | $12,977.28 | $22,734.57 | $28,660.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,977.28 / $22,923.82 / $30,059.98
| Facility | | $12,977.28 | $22,923.82 | $30,059.98 |