- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $11,924.30 / $19,474.50
| Facility | | $6,303.00 | $11,924.30 | $19,474.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,749.30 / $21,660.69 / $29,063.98
| Facility | | $15,749.30 | $21,660.69 | $29,063.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,903.80 / $17,720.34 / $24,841.01
| Facility | | $12,903.80 | $17,720.34 | $24,841.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,233.92 / $19,680.41 / $24,810.58
| Facility | | $11,233.92 | $19,680.41 | $24,810.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,233.92 / $19,844.25 / $26,021.74
| Facility | | $11,233.92 | $19,844.25 | $26,021.74 |