- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $10,417.20 / $17,013.09
| Facility | | $6,303.00 | $10,417.20 | $17,013.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,758.77 / $18,923.03 / $25,390.62
| Facility | | $13,758.77 | $18,923.03 | $25,390.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,272.90 / $15,480.69 / $21,701.38
| Facility | | $11,272.90 | $15,480.69 | $21,701.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,814.08 / $17,193.04 / $21,674.80
| Facility | | $9,814.08 | $17,193.04 | $21,674.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,814.08 / $17,336.16 / $22,732.89
| Facility | | $9,814.08 | $17,336.16 | $22,732.89 |