- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,901.74 / $10,810.60 / $15,306.60
| Facility | | $5,901.74 | $10,810.60 | $15,306.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,387.32 / $12,090.39 / $19,685.33
| Facility | | $7,387.32 | $12,090.39 | $19,685.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,136.02 / $12,420.79 / $27,221.00
| Facility | | $6,136.02 | $12,420.79 | $27,221.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,555.53 / $9,594.20 / $20,765.78
| Facility | | $4,555.53 | $9,594.20 | $20,765.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $9,433.67 / $20,459.31
| Facility | | $3,308.00 | $9,433.67 | $20,459.31 |