- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $14,518.70 / $23,711.50
| Facility | | $6,303.00 | $14,518.70 | $23,711.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,175.87 / $26,373.40 / $35,387.42
| Facility | | $19,175.87 | $26,373.40 | $35,387.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,711.27 / $21,575.75 / $30,245.65
| Facility | | $15,711.27 | $21,575.75 | $30,245.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,678.08 / $23,962.29 / $30,208.61
| Facility | | $13,678.08 | $23,962.29 | $30,208.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,678.08 / $24,161.76 / $31,683.28
| Facility | | $13,678.08 | $24,161.76 | $31,683.28 |