- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $10,404.00 / $16,991.50
| Facility | | $6,303.00 | $10,404.00 | $16,991.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,741.27 / $18,898.97 / $25,358.33
| Facility | | $13,741.27 | $18,898.97 | $25,358.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,258.57 / $15,461.00 / $21,673.79
| Facility | | $11,258.57 | $15,461.00 | $21,673.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,801.60 / $17,171.18 / $21,647.24
| Facility | | $9,801.60 | $17,171.18 | $21,647.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,801.60 / $17,314.12 / $22,703.98
| Facility | | $9,801.60 | $17,314.12 | $22,703.98 |