- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $12,935.20 / $21,125.40
| Facility | | $6,303.00 | $12,935.20 | $21,125.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,084.40 / $23,496.91 / $31,527.78
| Facility | | $17,084.40 | $23,496.91 | $31,527.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,997.67 / $19,222.52 / $26,946.82
| Facility | | $13,997.67 | $19,222.52 | $26,946.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,186.24 / $21,348.77 / $26,913.82
| Facility | | $12,186.24 | $21,348.77 | $26,913.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,186.24 / $21,526.49 / $28,227.65
| Facility | | $12,186.24 | $21,526.49 | $28,227.65 |