- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $14,705.20 / $24,016.10
| Facility | | $6,303.00 | $14,705.20 | $24,016.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,422.16 / $26,712.14 / $35,841.93
| Facility | | $19,422.16 | $26,712.14 | $35,841.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,913.06 / $21,852.86 / $30,634.13
| Facility | | $15,913.06 | $21,852.86 | $30,634.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,853.76 / $24,270.06 / $30,596.61
| Facility | | $13,853.76 | $24,270.06 | $30,596.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,853.76 / $24,472.09 / $32,090.21
| Facility | | $13,853.76 | $24,472.09 | $32,090.21 |