- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,530.00 / $13,793.10 / $19,529.59
| Facility | | $7,530.00 | $13,793.10 | $19,529.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,255.25 / $13,278.84 / $21,102.52
| Facility | | $8,255.25 | $13,278.84 | $21,102.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,828.92 / $12,407.65 / $22,075.18
| Facility | | $7,828.92 | $12,407.65 | $22,075.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,264.00 / $12,065.99 / $26,103.94
| Facility | | $5,264.00 | $12,065.99 | $26,103.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $11,451.57 / $23,197.33
| Facility | | $3,308.00 | $11,451.57 | $23,197.33 |