- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,024.89 / $11,036.10 / $15,626.00
| Facility | | $6,024.89 | $11,036.10 | $15,626.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,194.06 / $11,742.59 / $18,948.22
| Facility | | $7,194.06 | $11,742.59 | $18,948.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,264.06 / $9,927.59 / $17,662.75
| Facility | | $6,264.06 | $9,927.59 | $17,662.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,650.59 / $9,630.52 / $20,886.24
| Facility | | $4,650.59 | $9,630.52 | $20,886.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $9,162.61 / $18,560.59
| Facility | | $3,308.00 | $9,162.61 | $18,560.59 |