- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $11,680.80 / $19,076.70
| Facility | | $6,303.00 | $11,680.80 | $19,076.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,427.64 / $21,218.30 / $28,470.38
| Facility | | $15,427.64 | $21,218.30 | $28,470.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,640.25 / $17,358.41 / $24,333.66
| Facility | | $12,640.25 | $17,358.41 | $24,333.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,004.48 / $19,278.47 / $24,303.85
| Facility | | $11,004.48 | $19,278.47 | $24,303.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,004.48 / $19,438.96 / $25,490.27
| Facility | | $11,004.48 | $19,438.96 | $25,490.27 |