- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $13,882.90 / $22,673.10
| Facility | | $6,303.00 | $13,882.90 | $22,673.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,336.05 / $25,218.36 / $33,837.60
| Facility | | $18,336.05 | $25,218.36 | $33,837.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,023.18 / $20,630.82 / $28,921.03
| Facility | | $15,023.18 | $20,630.82 | $28,921.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,079.04 / $22,912.84 / $28,885.60
| Facility | | $13,079.04 | $22,912.84 | $28,885.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,079.04 / $23,103.58 / $30,295.69
| Facility | | $13,079.04 | $23,103.58 | $30,295.69 |