- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $11,918.20 / $19,464.50
| Facility | | $6,303.00 | $11,918.20 | $19,464.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,741.23 / $21,649.59 / $29,049.07
| Facility | | $15,741.23 | $21,649.59 | $29,049.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,897.18 / $17,711.25 / $24,828.27
| Facility | | $12,897.18 | $17,711.25 | $24,828.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,228.16 / $19,670.33 / $24,797.86
| Facility | | $11,228.16 | $19,670.33 | $24,797.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,228.16 / $19,834.08 / $26,008.40
| Facility | | $11,228.16 | $19,834.08 | $26,008.40 |