- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,553.20 / $9,556.75 / $15,513.60
| Facility | | $6,553.20 | $9,556.75 | $15,513.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,905.17 / $18,346.62 / $23,521.31
| Facility | | $12,905.17 | $18,346.62 | $23,521.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,695.00 / $14,877.56 / $18,817.41
| Facility | | $7,695.00 | $14,877.56 | $18,817.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,837.17 / $10,277.60 / $16,434.30
| Facility | | $6,837.17 | $10,277.60 | $16,434.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,998.64 / $13,673.25 / $20,773.64
| Facility | | $8,998.64 | $13,673.25 | $20,773.64 |