- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $13,223.60 / $21,596.30
| Facility | | $6,303.00 | $13,223.60 | $21,596.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,465.28 / $24,020.75 / $32,230.66
| Facility | | $17,465.28 | $24,020.75 | $32,230.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,309.74 / $19,651.07 / $27,547.58
| Facility | | $14,309.74 | $19,651.07 | $27,547.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,457.92 / $21,824.72 / $27,513.84
| Facility | | $12,457.92 | $21,824.72 | $27,513.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,457.92 / $22,006.40 / $28,856.95
| Facility | | $12,457.92 | $22,006.40 | $28,856.95 |