- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $13,393.70 / $21,874.20
| Facility | | $6,303.00 | $13,393.70 | $21,874.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,690.04 / $24,329.87 / $32,645.44
| Facility | | $17,690.04 | $24,329.87 | $32,645.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,493.89 / $19,903.96 / $27,902.08
| Facility | | $14,493.89 | $19,903.96 | $27,902.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,618.24 / $22,105.58 / $27,867.91
| Facility | | $12,618.24 | $22,105.58 | $27,867.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,618.24 / $22,289.60 / $29,228.31
| Facility | | $12,618.24 | $22,289.60 | $29,228.31 |