- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $11,272.20 / $18,409.40
| Facility | | $6,303.00 | $11,272.20 | $18,409.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,887.95 / $20,476.04 / $27,474.42
| Facility | | $14,887.95 | $20,476.04 | $27,474.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,198.07 / $16,751.18 / $23,482.41
| Facility | | $12,198.07 | $16,751.18 | $23,482.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,619.52 / $18,604.07 / $23,453.65
| Facility | | $10,619.52 | $18,604.07 | $23,453.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,619.52 / $18,758.93 / $24,598.57
| Facility | | $10,619.52 | $18,758.93 | $24,598.57 |