- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $13,787.10 / $22,516.60
| Facility | | $6,303.00 | $13,787.10 | $22,516.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,209.54 / $25,044.37 / $33,604.14
| Facility | | $18,209.54 | $25,044.37 | $33,604.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,919.53 / $20,488.48 / $28,721.48
| Facility | | $14,919.53 | $20,488.48 | $28,721.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,988.80 / $22,754.75 / $28,686.31
| Facility | | $12,988.80 | $22,754.75 | $28,686.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,988.80 / $22,944.17 / $30,086.66
| Facility | | $12,988.80 | $22,944.17 | $30,086.66 |