- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $11,525.90 / $18,823.80
| Facility | | $6,303.00 | $11,525.90 | $18,823.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,223.07 / $20,936.93 / $28,092.86
| Facility | | $15,223.07 | $20,936.93 | $28,092.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,472.64 / $17,128.25 / $24,010.99
| Facility | | $12,472.64 | $17,128.25 | $24,010.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,858.56 / $19,022.84 / $23,981.58
| Facility | | $10,858.56 | $19,022.84 | $23,981.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,858.56 / $19,181.18 / $25,152.27
| Facility | | $10,858.56 | $19,181.18 | $25,152.27 |