- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,416.75 / $9,922.17 / $14,048.70
| Facility | | $5,416.75 | $9,922.17 | $14,048.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,321.45 / $10,252.36 / $16,489.25
| Facility | | $6,321.45 | $10,252.36 | $16,489.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,631.78 / $8,925.52 / $15,879.91
| Facility | | $5,631.78 | $8,925.52 | $15,879.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,181.17 / $8,311.03 / $18,778.03
| Facility | | $4,181.17 | $8,311.03 | $18,778.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $8,291.00 / $16,687.13
| Facility | | $3,308.00 | $8,291.00 | $16,687.13 |