- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $13,468.10 / $21,995.70
| Facility | | $6,303.00 | $13,468.10 | $21,995.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,788.28 / $24,465.00 / $32,826.75
| Facility | | $17,788.28 | $24,465.00 | $32,826.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,574.39 / $20,014.50 / $28,057.05
| Facility | | $14,574.39 | $20,014.50 | $28,057.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,688.32 / $22,228.35 / $28,022.68
| Facility | | $12,688.32 | $22,228.35 | $28,022.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,688.32 / $22,413.39 / $29,390.64
| Facility | | $12,688.32 | $22,413.39 | $29,390.64 |