- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,875.96 / $14,426.90 / $20,426.90
| Facility | | $7,875.96 | $14,426.90 | $20,426.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,735.33 / $12,405.48 / $19,512.91
| Facility | | $7,735.33 | $12,405.48 | $19,512.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,064.55 / $12,977.72 / $23,089.43
| Facility | | $8,064.55 | $12,977.72 | $23,089.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,264.00 / $11,977.72 / $27,303.29
| Facility | | $5,264.00 | $11,977.72 | $27,303.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $11,977.72 / $24,263.13
| Facility | | $3,308.00 | $11,977.72 | $24,263.13 |