- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $10,427.40 / $17,029.80
| Facility | | $6,303.00 | $10,427.40 | $17,029.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,772.23 / $18,941.54 / $25,415.46
| Facility | | $13,772.23 | $18,941.54 | $25,415.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,283.93 / $15,495.83 / $21,722.61
| Facility | | $11,283.93 | $15,495.83 | $21,722.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,823.68 / $17,209.86 / $21,696.01
| Facility | | $9,823.68 | $17,209.86 | $21,696.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,028.34 / $15,088.56 / $22,129.89
| Facility | | $10,028.34 | $15,088.56 | $22,129.89 |