- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $12,046.60 / $19,674.20
| Facility | | $6,303.00 | $12,046.60 | $19,674.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,910.80 / $21,882.82 / $29,362.02
| Facility | | $15,910.80 | $21,882.82 | $29,362.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,036.12 / $17,902.05 / $25,095.74
| Facility | | $13,036.12 | $17,902.05 | $25,095.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,349.12 / $19,882.24 / $25,065.00
| Facility | | $11,349.12 | $19,882.24 | $25,065.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,349.12 / $20,047.75 / $26,288.58
| Facility | | $11,349.12 | $20,047.75 | $26,288.58 |