- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $12,642.70 / $20,647.70
| Facility | | $6,303.00 | $12,642.70 | $20,647.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,698.13 / $22,965.67 / $30,814.97
| Facility | | $16,698.13 | $22,965.67 | $30,814.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,681.20 / $18,787.91 / $26,337.58
| Facility | | $13,681.20 | $18,787.91 | $26,337.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,910.72 / $20,866.09 / $26,305.32
| Facility | | $11,910.72 | $20,866.09 | $26,305.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,910.72 / $21,039.79 / $27,589.45
| Facility | | $11,910.72 | $21,039.79 | $27,589.45 |