- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,365.58 / $13,492.00 / $19,103.20
| Facility | | $7,365.58 | $13,492.00 | $19,103.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,635.74 / $12,365.54 / $19,572.03
| Facility | | $7,635.74 | $12,365.54 | $19,572.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,657.98 / $12,136.74 / $21,593.18
| Facility | | $7,657.98 | $12,136.74 | $21,593.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,264.00 / $11,469.92 / $25,533.98
| Facility | | $5,264.00 | $11,469.92 | $25,533.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $11,201.54 / $22,690.83
| Facility | | $3,308.00 | $11,201.54 | $22,690.83 |