- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,253.86 / $13,287.30 / $18,813.40
| Facility | | $7,253.86 | $13,287.30 | $18,813.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,788.15 / $12,624.85 / $20,346.34
| Facility | | $7,788.15 | $12,624.85 | $20,346.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,541.82 / $11,952.64 / $21,265.65
| Facility | | $7,541.82 | $11,952.64 | $21,265.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,264.00 / $11,277.31 / $25,146.67
| Facility | | $5,264.00 | $11,277.31 | $25,146.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $11,031.63 / $22,346.64
| Facility | | $3,308.00 | $11,031.63 | $22,346.64 |