- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $13,535.40 / $22,105.60
| Facility | | $6,303.00 | $13,535.40 | $22,105.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,877.11 / $24,587.17 / $32,990.67
| Facility | | $17,877.11 | $24,587.17 | $32,990.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,647.16 / $20,114.45 / $28,197.15
| Facility | | $14,647.16 | $20,114.45 | $28,197.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,751.68 / $22,339.35 / $28,162.62
| Facility | | $12,751.68 | $22,339.35 | $28,162.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,751.68 / $22,525.31 / $29,537.41
| Facility | | $12,751.68 | $22,525.31 | $29,537.41 |