- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $11,475.00 / $18,740.59
| Facility | | $6,303.00 | $11,475.00 | $18,740.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,155.77 / $20,844.39 / $27,968.68
| Facility | | $15,155.77 | $20,844.39 | $27,968.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,417.50 / $17,052.53 / $23,904.85
| Facility | | $12,417.50 | $17,052.53 | $23,904.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,810.56 / $18,938.75 / $23,875.57
| Facility | | $10,810.56 | $18,938.75 | $23,875.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,810.56 / $19,096.40 / $25,041.09
| Facility | | $10,810.56 | $19,096.40 | $25,041.09 |