- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $12,426.70 / $20,294.90
| Facility | | $6,303.00 | $12,426.70 | $20,294.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,412.81 / $22,573.25 / $30,288.43
| Facility | | $16,412.81 | $22,573.25 | $30,288.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,447.43 / $18,466.89 / $25,887.55
| Facility | | $13,447.43 | $18,466.89 | $25,887.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,707.20 / $20,509.55 / $25,855.84
| Facility | | $11,707.20 | $20,509.55 | $25,855.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,707.20 / $20,680.28 / $27,118.02
| Facility | | $11,707.20 | $20,680.28 | $27,118.02 |