- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $10,342.79 / $16,891.59
| Facility | | $6,303.00 | $10,342.79 | $16,891.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,660.52 / $18,787.90 / $25,209.31
| Facility | | $13,660.52 | $18,787.90 | $25,209.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,192.41 / $15,370.15 / $21,546.42
| Facility | | $11,192.41 | $15,370.15 | $21,546.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,744.00 / $17,070.27 / $21,520.03
| Facility | | $9,744.00 | $17,070.27 | $21,520.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,947.00 / $14,966.18 / $21,950.39
| Facility | | $9,947.00 | $14,966.18 | $21,950.39 |