- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $10,217.50 / $16,686.90
| Facility | | $6,303.00 | $10,217.50 | $16,686.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,494.98 / $18,560.23 / $24,903.82
| Facility | | $13,494.98 | $18,560.23 | $24,903.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,056.77 / $15,183.89 / $21,285.32
| Facility | | $11,056.77 | $15,183.89 | $21,285.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,625.92 / $16,863.41 / $21,259.25
| Facility | | $9,625.92 | $16,863.41 | $21,259.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,625.92 / $17,003.79 / $22,297.04
| Facility | | $9,625.92 | $17,003.79 | $22,297.04 |