- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,308.26 / $15,218.70 / $21,548.10
| Facility | | $8,308.26 | $15,218.70 | $21,548.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,654.48 / $15,774.54 / $25,511.79
| Facility | | $9,654.48 | $15,774.54 | $25,511.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,638.08 / $13,690.05 / $24,356.77
| Facility | | $8,638.08 | $13,690.05 | $24,356.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,496.96 / $12,916.55 / $28,801.92
| Facility | | $5,496.96 | $12,916.55 | $28,801.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $12,635.16 / $25,594.89
| Facility | | $3,308.00 | $12,635.16 | $25,594.89 |