- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $13,748.30 / $22,453.40
| Facility | | $6,303.00 | $13,748.30 | $22,453.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,158.40 / $24,974.03 / $33,509.76
| Facility | | $18,158.40 | $24,974.03 | $33,509.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,877.63 / $20,430.93 / $28,640.82
| Facility | | $14,877.63 | $20,430.93 | $28,640.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,952.32 / $22,690.85 / $28,605.74
| Facility | | $12,952.32 | $22,690.85 | $28,605.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,952.32 / $22,879.73 / $30,002.16
| Facility | | $12,952.32 | $22,879.73 | $30,002.16 |