- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $14,069.30 / $22,977.60
| Facility | | $6,303.00 | $14,069.30 | $22,977.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,582.34 / $25,557.10 / $34,292.11
| Facility | | $18,582.34 | $25,557.10 | $34,292.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,224.98 / $20,907.93 / $29,309.50
| Facility | | $15,224.98 | $20,907.93 | $29,309.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,254.72 / $23,220.61 / $29,273.60
| Facility | | $13,254.72 | $23,220.61 | $29,273.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,254.72 / $23,413.91 / $30,702.63
| Facility | | $13,254.72 | $23,413.91 | $30,702.63 |