- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $13,917.50 / $22,729.60
| Facility | | $6,303.00 | $13,917.50 | $22,729.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,381.81 / $25,281.30 / $33,922.05
| Facility | | $18,381.81 | $25,281.30 | $33,922.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,060.68 / $20,682.31 / $28,993.20
| Facility | | $15,060.68 | $20,682.31 | $28,993.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,111.68 / $22,970.02 / $28,957.69
| Facility | | $13,111.68 | $22,970.02 | $28,957.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,111.68 / $23,161.24 / $30,371.29
| Facility | | $13,111.68 | $23,161.24 | $30,371.29 |