- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $10,454.90 / $17,074.70
| Facility | | $6,303.00 | $10,454.90 | $17,074.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,808.56 / $18,991.52 / $25,482.52
| Facility | | $13,808.56 | $18,991.52 | $25,482.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,313.70 / $15,536.72 / $21,779.93
| Facility | | $11,313.70 | $15,536.72 | $21,779.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,849.60 / $17,255.27 / $21,753.25
| Facility | | $9,849.60 | $17,255.27 | $21,753.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,849.60 / $17,398.91 / $22,815.16
| Facility | | $9,849.60 | $17,398.91 | $22,815.16 |