- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $13,482.40 / $22,019.00
| Facility | | $6,303.00 | $13,482.40 | $22,019.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,807.13 / $24,490.91 / $32,861.51
| Facility | | $17,807.13 | $24,490.91 | $32,861.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,589.82 / $20,035.70 / $28,086.77
| Facility | | $14,589.82 | $20,035.70 | $28,086.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,701.76 / $22,251.90 / $28,052.37
| Facility | | $12,701.76 | $22,251.90 | $28,052.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,966.38 / $20,190.50 / $28,613.36
| Facility | | $12,966.38 | $20,190.50 | $28,613.36 |