- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,632.20 / $13,980.30 / $19,794.70
| Facility | | $7,632.20 | $13,980.30 | $19,794.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,561.24 / $13,747.74 / $22,005.61
| Facility | | $8,561.24 | $13,747.74 | $22,005.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,935.18 / $12,576.06 / $22,374.80
| Facility | | $7,935.18 | $12,576.06 | $22,374.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,264.00 / $11,865.50 / $26,458.25
| Facility | | $5,264.00 | $11,865.50 | $26,458.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $11,607.00 / $23,512.18
| Facility | | $3,308.00 | $11,607.00 | $23,512.18 |