- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,947.06 / $14,557.10 / $20,611.30
| Facility | | $7,947.06 | $14,557.10 | $20,611.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,024.05 / $12,975.12 / $21,463.26
| Facility | | $8,024.05 | $12,975.12 | $21,463.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,262.54 / $13,094.87 / $23,297.86
| Facility | | $8,262.54 | $13,094.87 | $23,297.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,264.00 / $10,760.08 / $27,549.76
| Facility | | $5,264.00 | $10,760.08 | $27,549.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $12,085.84 / $24,482.16
| Facility | | $3,308.00 | $12,085.84 | $24,482.16 |