- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $11,644.10 / $19,016.80
| Facility | | $6,303.00 | $11,644.10 | $19,016.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,379.19 / $21,151.66 / $28,380.97
| Facility | | $15,379.19 | $21,151.66 | $28,380.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,600.55 / $17,303.91 / $24,257.24
| Facility | | $12,600.55 | $17,303.91 | $24,257.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,969.92 / $19,217.93 / $24,227.53
| Facility | | $10,969.92 | $19,217.93 | $24,227.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,969.92 / $19,377.91 / $25,410.22
| Facility | | $10,969.92 | $19,377.91 | $25,410.22 |