- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $14,136.60 / $23,087.40
| Facility | | $6,303.00 | $14,136.60 | $23,087.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,671.16 / $25,679.27 / $34,456.04
| Facility | | $18,671.16 | $25,679.27 | $34,456.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,297.76 / $21,007.88 / $29,449.60
| Facility | | $15,297.76 | $21,007.88 | $29,449.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,318.08 / $23,331.61 / $29,413.53
| Facility | | $13,318.08 | $23,331.61 | $29,413.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,318.08 / $23,525.83 / $30,849.39
| Facility | | $13,318.08 | $23,525.83 | $30,849.39 |