- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $12,026.20 / $19,640.90
| Facility | | $6,303.00 | $12,026.20 | $19,640.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,883.89 / $21,845.80 / $29,312.34
| Facility | | $15,883.89 | $21,845.80 | $29,312.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,014.07 / $17,871.77 / $25,053.29
| Facility | | $13,014.07 | $17,871.77 | $25,053.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,329.92 / $19,848.59 / $25,022.60
| Facility | | $11,329.92 | $19,848.59 | $25,022.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,329.92 / $20,013.83 / $26,244.11
| Facility | | $11,329.92 | $20,013.83 | $26,244.11 |