- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $14,258.90 / $23,287.20
| Facility | | $6,303.00 | $14,258.90 | $23,287.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,832.68 / $25,901.39 / $34,754.08
| Facility | | $18,832.68 | $25,901.39 | $34,754.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,430.08 / $21,189.60 / $29,704.34
| Facility | | $15,430.08 | $21,189.60 | $29,704.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,433.28 / $23,533.43 / $29,667.96
| Facility | | $13,433.28 | $23,533.43 | $29,667.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,433.28 / $23,729.33 / $31,116.23
| Facility | | $13,433.28 | $23,729.33 | $31,116.23 |