- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $14,452.50 / $23,603.30
| Facility | | $6,303.00 | $14,452.50 | $23,603.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,088.39 / $26,253.09 / $35,225.98
| Facility | | $19,088.39 | $26,253.09 | $35,225.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,639.59 / $21,477.32 / $30,107.67
| Facility | | $15,639.59 | $21,477.32 | $30,107.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,615.68 / $23,852.97 / $30,070.80
| Facility | | $13,615.68 | $23,852.97 | $30,070.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,615.68 / $24,051.53 / $31,538.74
| Facility | | $13,615.68 | $24,051.53 | $31,538.74 |