- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $13,330.60 / $21,771.10
| Facility | | $6,303.00 | $13,330.60 | $21,771.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,606.59 / $24,215.11 / $32,491.45
| Facility | | $17,606.59 | $24,215.11 | $32,491.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,425.52 / $19,810.07 / $27,770.47
| Facility | | $14,425.52 | $19,810.07 | $27,770.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,558.72 / $22,001.31 / $27,736.46
| Facility | | $12,558.72 | $22,001.31 | $27,736.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,558.72 / $22,184.46 / $29,090.44
| Facility | | $12,558.72 | $22,184.46 | $29,090.44 |