- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,554.12 / $13,837.30 / $19,592.20
| Facility | | $7,554.12 | $13,837.30 | $19,592.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,527.87 / $12,098.54 / $19,011.68
| Facility | | $7,527.87 | $12,098.54 | $19,011.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,769.00 / $11,907.14 / $22,145.90
| Facility | | $6,769.00 | $11,907.14 | $22,145.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,264.00 / $11,488.26 / $26,187.57
| Facility | | $5,264.00 | $11,488.26 | $26,187.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $10,631.32 / $23,271.64
| Facility | | $3,308.00 | $10,631.32 | $23,271.64 |