- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,767.00 / $19,576.90 / $25,730.70
| Facility | | $5,767.00 | $19,576.90 | $25,730.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,812.48 / $18,552.96 / $31,379.83
| Facility | | $6,812.48 | $18,552.96 | $31,379.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,110.53 / $19,663.87 / $32,912.87
| Facility | | $14,110.53 | $19,663.87 | $32,912.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,863.03 / $21,945.14 / $32,041.70
| Facility | | $16,863.03 | $21,945.14 | $32,041.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,181.61 / $19,191.43 / $29,915.09
| Facility | | $11,181.61 | $19,191.43 | $29,915.09 |