- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $13,568.00 / $22,158.80
| Facility | | $6,303.00 | $13,568.00 | $22,158.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,920.18 / $24,646.40 / $33,070.15
| Facility | | $17,920.18 | $24,646.40 | $33,070.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,682.45 / $20,162.90 / $28,265.08
| Facility | | $14,682.45 | $20,162.90 | $28,265.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,782.40 / $22,393.17 / $28,230.46
| Facility | | $12,782.40 | $22,393.17 | $28,230.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,782.40 / $22,579.58 / $29,608.57
| Facility | | $12,782.40 | $22,579.58 | $29,608.57 |