- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $13,081.90 / $21,365.00
| Facility | | $6,303.00 | $13,081.90 | $21,365.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,278.20 / $23,763.46 / $31,885.43
| Facility | | $17,278.20 | $23,763.46 | $31,885.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,156.46 / $19,440.58 / $27,252.51
| Facility | | $14,156.46 | $19,440.58 | $27,252.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,324.48 / $21,590.95 / $27,219.13
| Facility | | $12,324.48 | $21,590.95 | $27,219.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,324.48 / $21,770.68 / $28,547.86
| Facility | | $12,324.48 | $21,770.68 | $28,547.86 |