- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,013.42 / $15,385.60 / $25,008.00
| Facility | | $9,013.42 | $15,385.60 | $25,008.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,513.40 / $12,401.76 / $17,250.16
| Facility | | $10,513.40 | $12,401.76 | $17,250.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,728.95 / $12,224.59 / $19,285.48
| Facility | | $7,728.95 | $12,224.59 | $19,285.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,410.21 / $11,482.30 / $21,075.56
| Facility | | $6,410.21 | $11,482.30 | $21,075.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,289.00 / $12,946.55 / $17,582.45
| Facility | | $6,289.00 | $12,946.55 | $17,582.45 |