- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,445.12 / $11,805.90 / $16,715.90
| Facility | | $6,445.12 | $11,805.90 | $16,715.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,978.08 / $14,595.91 / $23,552.44
| Facility | | $8,978.08 | $14,595.91 | $23,552.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,700.98 / $10,620.04 / $18,894.73
| Facility | | $6,700.98 | $10,620.04 | $18,894.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,974.97 / $10,020.00 / $22,343.06
| Facility | | $4,974.97 | $10,020.00 | $22,343.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $9,801.70 / $19,855.21
| Facility | | $3,308.00 | $9,801.70 | $19,855.21 |