- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,428.43 / $13,607.10 / $19,266.20
| Facility | | $7,428.43 | $13,607.10 | $19,266.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,985.95 / $14,453.95 / $23,097.28
| Facility | | $8,985.95 | $14,453.95 | $23,097.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,723.32 / $12,240.29 / $21,777.42
| Facility | | $7,723.32 | $12,240.29 | $21,777.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,264.00 / $11,932.53 / $25,751.84
| Facility | | $5,264.00 | $11,932.53 | $25,751.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $11,297.11 / $22,884.43
| Facility | | $3,308.00 | $11,297.11 | $22,884.43 |