- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $11,591.10 / $18,930.30
| Facility | | $6,303.00 | $11,591.10 | $18,930.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,309.20 / $21,055.41 / $28,251.81
| Facility | | $15,309.20 | $21,055.41 | $28,251.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,543.21 / $17,225.16 / $24,146.85
| Facility | | $12,543.21 | $17,225.16 | $24,146.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,920.00 / $19,130.48 / $24,117.28
| Facility | | $10,920.00 | $19,130.48 | $24,117.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,920.00 / $19,289.73 / $25,294.59
| Facility | | $10,920.00 | $19,289.73 | $25,294.59 |