- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $14,591.10 / $23,829.70
| Facility | | $6,303.00 | $14,591.10 | $23,829.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,271.43 / $26,504.83 / $35,563.76
| Facility | | $19,271.43 | $26,504.83 | $35,563.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,789.56 / $21,683.26 / $30,396.37
| Facility | | $15,789.56 | $21,683.26 | $30,396.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,746.24 / $24,081.69 / $30,359.14
| Facility | | $13,746.24 | $24,081.69 | $30,359.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,746.24 / $24,282.16 / $31,841.16
| Facility | | $13,746.24 | $24,282.16 | $31,841.16 |