- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $10,213.40 / $16,680.30
| Facility | | $6,303.00 | $10,213.40 | $16,680.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,489.59 / $18,552.82 / $24,893.88
| Facility | | $13,489.59 | $18,552.82 | $24,893.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,052.36 / $15,177.83 / $21,276.82
| Facility | | $11,052.36 | $15,177.83 | $21,276.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,622.08 / $16,856.68 / $21,250.76
| Facility | | $9,622.08 | $16,856.68 | $21,250.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,622.08 / $16,997.00 / $22,288.15
| Facility | | $9,622.08 | $16,997.00 | $22,288.15 |