- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $12,251.40 / $20,008.70
| Facility | | $6,303.00 | $12,251.40 | $20,008.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,181.32 / $22,254.87 / $29,861.24
| Facility | | $16,181.32 | $22,254.87 | $29,861.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,257.76 / $18,206.43 / $25,522.42
| Facility | | $13,257.76 | $18,206.43 | $25,522.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,542.08 / $20,220.28 / $25,491.16
| Facility | | $11,542.08 | $20,220.28 | $25,491.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,542.08 / $20,388.59 / $26,735.55
| Facility | | $11,542.08 | $20,388.59 | $26,735.55 |