- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,685.27 / $10,414.00 / $14,745.20
| Facility | | $5,685.27 | $10,414.00 | $14,745.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.95 / $8,660.35 / $13,707.49
| Facility | | $5,341.95 | $8,660.35 | $13,707.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,910.96 / $9,367.98 / $16,667.12
| Facility | | $5,910.96 | $9,367.98 | $16,667.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,388.43 / $8,867.04 / $19,708.90
| Facility | | $4,388.43 | $8,867.04 | $19,708.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $8,646.12 / $17,514.34
| Facility | | $3,308.00 | $8,646.12 | $17,514.34 |