- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $14,193.70 / $23,180.60
| Facility | | $6,303.00 | $14,193.70 | $23,180.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,746.54 / $25,782.93 / $34,595.12
| Facility | | $18,746.54 | $25,782.93 | $34,595.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,359.51 / $21,092.68 / $29,568.48
| Facility | | $15,359.51 | $21,092.68 | $29,568.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,371.84 / $23,382.00 / $29,532.27
| Facility | | $13,371.84 | $23,382.00 | $29,532.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,371.84 / $23,620.80 / $30,973.92
| Facility | | $13,371.84 | $23,620.80 | $30,973.92 |