- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $10,192.00 / $16,645.30
| Facility | | $6,303.00 | $10,192.00 | $16,645.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,461.33 / $18,513.95 / $24,841.73
| Facility | | $13,461.33 | $18,513.95 | $24,841.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,029.21 / $15,146.03 / $21,232.25
| Facility | | $11,029.21 | $15,146.03 | $21,232.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,601.92 / $16,821.36 / $21,206.24
| Facility | | $9,601.92 | $16,821.36 | $21,206.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,601.92 / $16,961.39 / $22,241.45
| Facility | | $9,601.92 | $16,961.39 | $22,241.45 |