- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,921.14 / $13,809.80 / $15,627.90
| Facility | | $8,921.14 | $13,809.80 | $15,627.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,924.60 / $13,498.20 / $18,230.33
| Facility | | $8,924.60 | $13,498.20 | $18,230.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,238.03 / $12,826.93 / $17,323.37
| Facility | | $8,238.03 | $12,826.93 | $17,323.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,445.00 / $14,447.00 / $19,082.00
| Facility | | $8,445.00 | $14,447.00 | $19,082.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,274.00 / $15,960.33 / $21,241.92
| Facility | | $5,274.00 | $15,960.33 | $21,241.92 |