- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $13,686.20 / $22,351.90
| Facility | | $6,303.00 | $13,686.20 | $22,351.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,076.30 / $24,861.12 / $33,358.25
| Facility | | $18,076.30 | $24,861.12 | $33,358.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,810.36 / $20,338.56 / $28,511.33
| Facility | | $14,810.36 | $20,338.56 | $28,511.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,893.76 / $22,588.26 / $28,476.41
| Facility | | $12,893.76 | $22,588.26 | $28,476.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,893.76 / $22,776.29 / $29,866.51
| Facility | | $12,893.76 | $22,776.29 | $29,866.51 |