- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,643.45 / $16,461.00 / $26,756.10
| Facility | | $9,643.45 | $16,461.00 | $26,756.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,640.00 / $14,758.83 / $18,295.23
| Facility | | $9,640.00 | $14,758.83 | $18,295.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,318.95 / $13,079.09 / $20,633.53
| Facility | | $8,318.95 | $13,079.09 | $20,633.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,099.96 / $13,127.69 / $24,744.43
| Facility | | $7,099.96 | $13,127.69 | $24,744.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,289.00 / $13,851.51 / $18,790.13
| Facility | | $6,289.00 | $13,851.51 | $18,790.13 |