- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $10,296.00 / $16,815.09
| Facility | | $6,303.00 | $10,296.00 | $16,815.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,598.61 / $18,702.75 / $25,095.06
| Facility | | $13,598.61 | $18,702.75 | $25,095.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,141.68 / $15,300.49 / $21,448.77
| Facility | | $11,141.68 | $15,300.49 | $21,448.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,699.84 / $16,992.91 / $21,422.50
| Facility | | $9,699.84 | $16,992.91 | $21,422.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,699.84 / $17,134.36 / $22,468.26
| Facility | | $9,699.84 | $17,134.36 | $22,468.26 |