- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $12,325.80 / $20,130.20
| Facility | | $6,303.00 | $12,325.80 | $20,130.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,279.57 / $22,390.00 / $30,042.54
| Facility | | $16,279.57 | $22,390.00 | $30,042.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,338.26 / $18,316.97 / $25,677.39
| Facility | | $13,338.26 | $18,316.97 | $25,677.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,612.16 / $20,343.05 / $25,645.94
| Facility | | $11,612.16 | $20,343.05 | $25,645.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,612.16 / $20,512.40 / $26,897.88
| Facility | | $11,612.16 | $20,512.40 | $26,897.88 |