- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $10,370.40 / $16,936.59
| Facility | | $6,303.00 | $10,370.40 | $16,936.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,696.86 / $18,837.88 / $25,276.37
| Facility | | $13,696.86 | $18,837.88 | $25,276.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,222.18 / $15,411.03 / $21,603.74
| Facility | | $11,222.18 | $15,411.03 | $21,603.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,769.92 / $17,115.68 / $21,577.28
| Facility | | $9,769.92 | $17,115.68 | $21,577.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,769.92 / $17,258.16 / $22,630.59
| Facility | | $9,769.92 | $17,258.16 | $22,630.59 |