- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $12,088.40 / $19,742.40
| Facility | | $6,303.00 | $12,088.40 | $19,742.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,965.98 / $21,958.71 / $29,463.85
| Facility | | $15,965.98 | $21,958.71 | $29,463.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,081.33 / $17,964.14 / $25,182.78
| Facility | | $13,081.33 | $17,964.14 | $25,182.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,388.48 / $19,951.18 / $25,151.93
| Facility | | $11,388.48 | $19,951.18 | $25,151.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,388.48 / $20,117.28 / $26,379.75
| Facility | | $11,388.48 | $20,117.28 | $26,379.75 |