- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $14,532.00 / $23,733.20
| Facility | | $6,303.00 | $14,532.00 | $23,733.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,193.37 / $26,397.47 / $35,419.69
| Facility | | $19,193.37 | $26,397.47 | $35,419.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,725.60 / $21,595.43 / $30,273.25
| Facility | | $15,725.60 | $21,595.43 | $30,273.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,690.56 / $23,984.15 / $30,236.17
| Facility | | $13,690.56 | $23,984.15 | $30,236.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,690.56 / $24,183.80 / $31,712.19
| Facility | | $13,690.56 | $24,183.80 | $31,712.19 |