- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $14,309.80 / $23,370.40
| Facility | | $6,303.00 | $14,309.80 | $23,370.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,899.97 / $25,993.94 / $34,878.26
| Facility | | $18,899.97 | $25,993.94 | $34,878.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,485.22 / $21,265.31 / $29,810.48
| Facility | | $15,485.22 | $21,265.31 | $29,810.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,481.28 / $23,617.52 / $29,773.97
| Facility | | $13,481.28 | $23,617.52 | $29,773.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,481.28 / $23,814.12 / $31,227.42
| Facility | | $13,481.28 | $23,814.12 | $31,227.42 |