- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $10,266.40 / $16,766.80
| Facility | | $6,303.00 | $10,266.40 | $16,766.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,559.58 / $18,649.08 / $25,023.04
| Facility | | $13,559.58 | $18,649.08 | $25,023.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,109.70 / $15,256.57 / $21,387.21
| Facility | | $11,109.70 | $15,256.57 | $21,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,672.00 / $16,944.14 / $21,361.02
| Facility | | $9,672.00 | $16,944.14 | $21,361.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,672.00 / $17,085.18 / $22,403.78
| Facility | | $9,672.00 | $17,085.18 | $22,403.78 |