- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $10,345.90 / $16,896.59
| Facility | | $6,303.00 | $10,345.90 | $16,896.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,664.56 / $18,793.46 / $25,216.76
| Facility | | $13,664.56 | $18,793.46 | $25,216.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,195.71 / $15,374.69 / $21,552.79
| Facility | | $11,195.71 | $15,374.69 | $21,552.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,746.87 / $17,075.32 / $21,526.39
| Facility | | $9,746.87 | $17,075.32 | $21,526.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,746.87 / $17,217.46 / $22,577.23
| Facility | | $9,746.87 | $17,217.46 | $22,577.23 |