- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $14,244.60 / $23,263.90
| Facility | | $6,303.00 | $14,244.60 | $23,263.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,813.83 / $25,875.48 / $34,719.31
| Facility | | $18,813.83 | $25,875.48 | $34,719.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,414.64 / $21,168.40 / $29,674.62
| Facility | | $15,414.64 | $21,168.40 | $29,674.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,419.84 / $23,509.88 / $29,638.28
| Facility | | $13,419.84 | $23,509.88 | $29,638.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,419.84 / $23,705.59 / $31,085.10
| Facility | | $13,419.84 | $23,705.59 | $31,085.10 |