- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $11,753.10 / $19,194.90
| Facility | | $6,303.00 | $11,753.10 | $19,194.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,523.20 / $21,349.72 / $28,646.72
| Facility | | $15,523.20 | $21,349.72 | $28,646.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,718.54 / $17,465.93 / $24,484.38
| Facility | | $12,718.54 | $17,465.93 | $24,484.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,072.64 / $19,397.88 / $24,454.39
| Facility | | $11,072.64 | $19,397.88 | $24,454.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,072.64 / $19,559.36 / $25,648.16
| Facility | | $11,072.64 | $19,559.36 | $25,648.16 |