- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $10,389.70 / $16,968.20
| Facility | | $6,303.00 | $10,389.70 | $16,968.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,722.43 / $18,873.05 / $25,323.56
| Facility | | $13,722.43 | $18,873.05 | $25,323.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,243.13 / $15,439.80 / $21,644.07
| Facility | | $11,243.13 | $15,439.80 | $21,644.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,788.16 / $17,147.63 / $21,617.56
| Facility | | $9,788.16 | $17,147.63 | $21,617.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,788.16 / $17,290.38 / $22,672.85
| Facility | | $9,788.16 | $17,290.38 | $22,672.85 |