- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $12,591.80 / $20,564.50
| Facility | | $6,303.00 | $12,591.80 | $20,564.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,630.84 / $22,873.12 / $30,690.78
| Facility | | $16,630.84 | $22,873.12 | $30,690.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,626.06 / $18,712.21 / $26,231.44
| Facility | | $13,626.06 | $18,712.21 | $26,231.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,862.72 / $20,782.00 / $26,199.31
| Facility | | $11,862.72 | $20,782.00 | $26,199.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,862.72 / $20,955.00 / $27,478.26
| Facility | | $11,862.72 | $20,955.00 | $27,478.26 |