- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $13,750.40 / $22,456.70
| Facility | | $6,303.00 | $13,750.40 | $22,456.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,161.09 / $24,977.73 / $33,514.72
| Facility | | $18,161.09 | $24,977.73 | $33,514.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,879.83 / $20,433.96 / $28,645.06
| Facility | | $14,879.83 | $20,433.96 | $28,645.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,954.24 / $22,694.21 / $28,609.98
| Facility | | $12,954.24 | $22,694.21 | $28,609.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,954.24 / $22,883.13 / $30,006.61
| Facility | | $12,954.24 | $22,883.13 | $30,006.61 |