- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,973.00 / $11,881.60 / $21,710.40
| Facility | | $1,973.00 | $11,881.60 | $21,710.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,808.70 / $13,095.90 / $22,149.96
| Facility | | $4,808.70 | $13,095.90 | $22,149.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,653.75 / $20,485.25 / $32,560.71
| Facility | | $12,653.75 | $20,485.25 | $32,560.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,945.48 / $19,449.68 / $28,398.13
| Facility | | $14,945.48 | $19,449.68 | $28,398.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,945.48 / $18,081.08 / $28,398.13
| Facility | | $14,945.48 | $18,081.08 | $28,398.13 |