- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,858.35 / $16,827.80 / $27,352.30
| Facility | | $9,858.35 | $16,827.80 | $27,352.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,687.00 / $13,607.00 / $16,696.55
| Facility | | $9,687.00 | $13,607.00 | $16,696.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,453.48 / $13,370.54 / $21,093.33
| Facility | | $8,453.48 | $13,370.54 | $21,093.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,453.68 / $13,169.50 / $24,387.52
| Facility | | $7,453.68 | $13,169.50 | $24,387.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,289.00 / $14,160.18 / $19,208.84
| Facility | | $6,289.00 | $14,160.18 | $19,208.84 |