- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,806.52 / $10,636.10 / $15,059.60
| Facility | | $5,806.52 | $10,636.10 | $15,059.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,926.92 / $9,561.92 / $15,087.49
| Facility | | $5,926.92 | $9,561.92 | $15,087.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,037.02 / $9,567.76 / $17,022.57
| Facility | | $6,037.02 | $9,567.76 | $17,022.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,482.03 / $8,830.51 / $20,129.22
| Facility | | $4,482.03 | $8,830.51 | $20,129.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $8,830.51 / $18,581.24
| Facility | | $3,308.00 | $8,830.51 | $18,581.24 |