- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $13,063.60 / $21,335.00
| Facility | | $6,303.00 | $13,063.60 | $21,335.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,253.98 / $23,730.14 / $31,840.73
| Facility | | $17,253.98 | $23,730.14 | $31,840.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,136.61 / $19,413.33 / $27,214.30
| Facility | | $14,136.61 | $19,413.33 | $27,214.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,307.20 / $21,560.68 / $27,180.96
| Facility | | $12,307.20 | $21,560.68 | $27,180.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,307.20 / $21,740.16 / $28,507.83
| Facility | | $12,307.20 | $21,740.16 | $28,507.83 |