- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,729.70 / $10,495.40 / $14,860.40
| Facility | | $5,729.70 | $10,495.40 | $14,860.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,519.52 / $11,038.22 / $11,354.34
| Facility | | $6,519.52 | $11,038.22 | $11,354.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,010.31 / $9,614.25 / $15,121.95
| Facility | | $6,010.31 | $9,614.25 | $15,121.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,957.16 / $9,441.20 / $16,797.39
| Facility | | $5,957.16 | $9,441.20 | $16,797.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,422.74 / $9,031.68 / $19,862.93
| Facility | | $4,422.74 | $9,031.68 | $19,862.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $8,713.70 / $17,651.25
| Facility | | $3,308.00 | $8,713.70 | $17,651.25 |