- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $12,193.40 / $19,913.80
| Facility | | $6,303.00 | $12,193.40 | $19,913.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,104.61 / $22,149.37 / $29,719.67
| Facility | | $16,104.61 | $22,149.37 | $29,719.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,194.91 / $18,120.11 / $25,401.42
| Facility | | $13,194.91 | $18,120.11 | $25,401.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,487.36 / $20,124.41 / $25,370.31
| Facility | | $11,487.36 | $20,124.41 | $25,370.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,487.36 / $20,291.93 / $26,608.79
| Facility | | $11,487.36 | $20,291.93 | $26,608.79 |