- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,452.36 / $15,482.70 / $21,921.80
| Facility | | $8,452.36 | $15,482.70 | $21,921.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.35 / $14,986.00 / $23,987.66
| Facility | | $9,332.35 | $14,986.00 | $23,987.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,787.90 / $13,927.49 / $24,779.22
| Facility | | $8,787.90 | $13,927.49 | $24,779.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,592.30 / $13,510.73 / $29,301.47
| Facility | | $5,592.30 | $13,510.73 | $29,301.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $12,854.30 / $26,038.81
| Facility | | $3,308.00 | $12,854.30 | $26,038.81 |