- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,663.31 / $14,037.30 / $19,875.30
| Facility | | $7,663.31 | $14,037.30 | $19,875.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,567.45 / $13,785.68 / $21,662.88
| Facility | | $8,567.45 | $13,785.68 | $21,662.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,967.52 / $12,627.31 / $22,465.99
| Facility | | $7,967.52 | $12,627.31 | $22,465.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,264.00 / $11,913.86 / $26,566.08
| Facility | | $5,264.00 | $11,913.86 | $26,566.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $11,654.31 / $23,608.00
| Facility | | $3,308.00 | $11,654.31 | $23,608.00 |