- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,625.60 / $10,304.70 / $14,590.40
| Facility | | $5,625.60 | $10,304.70 | $14,590.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,017.65 / $9,759.64 / $15,696.79
| Facility | | $6,017.65 | $9,759.64 | $15,696.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,848.92 / $9,269.65 / $16,492.18
| Facility | | $5,848.92 | $9,269.65 | $16,492.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,342.38 / $8,555.37 / $18,002.29
| Facility | | $4,342.38 | $8,555.37 | $18,002.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $8,555.37 / $17,330.53
| Facility | | $3,308.00 | $8,555.37 | $17,330.53 |