- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,642.99 / $14,000.10 / $19,822.70
| Facility | | $7,642.99 | $14,000.10 | $19,822.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,748.91 / $14,072.65 / $22,487.97
| Facility | | $8,748.91 | $14,072.65 | $22,487.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,946.40 / $12,593.84 / $22,406.44
| Facility | | $7,946.40 | $12,593.84 | $22,406.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,264.00 / $11,882.28 / $26,495.66
| Facility | | $5,264.00 | $11,882.28 | $26,495.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $11,623.42 / $23,545.42
| Facility | | $3,308.00 | $11,623.42 | $23,545.42 |