- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,596.02 / $13,914.10 / $19,700.80
| Facility | | $7,596.02 | $13,914.10 | $19,700.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,568.11 / $12,270.16 / $19,452.34
| Facility | | $7,568.11 | $12,270.16 | $19,452.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,475.00 / $11,973.18 / $22,268.73
| Facility | | $6,475.00 | $11,973.18 | $22,268.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,264.00 / $11,809.25 / $26,332.81
| Facility | | $5,264.00 | $11,809.25 | $26,332.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $11,551.98 / $23,400.71
| Facility | | $3,308.00 | $11,551.98 | $23,400.71 |