- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $12,956.60 / $21,160.30
| Facility | | $6,303.00 | $12,956.60 | $21,160.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,112.66 / $23,535.78 / $31,579.94
| Facility | | $17,112.66 | $23,535.78 | $31,579.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,020.83 / $19,254.32 / $26,991.40
| Facility | | $14,020.83 | $19,254.32 | $26,991.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,206.40 / $21,384.09 / $26,958.34
| Facility | | $12,206.40 | $21,384.09 | $26,958.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,206.40 / $21,562.10 / $28,274.35
| Facility | | $12,206.40 | $21,562.10 | $28,274.35 |