- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,000.00 / $13,049.60 / $19,893.50
| Facility | | $7,000.00 | $13,049.60 | $19,893.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,987.89 / $16,010.60 / $25,166.95
| Facility | | $9,987.89 | $16,010.60 | $25,166.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,974.78 / $12,638.82 / $22,486.46
| Facility | | $7,974.78 | $12,638.82 | $22,486.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,264.00 / $12,630.29 / $26,590.28
| Facility | | $5,264.00 | $12,630.29 | $26,590.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $11,284.31 / $23,629.51
| Facility | | $3,308.00 | $11,284.31 | $23,629.51 |