- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,548.79 / $10,164.00 / $14,391.20
| Facility | | $5,548.79 | $10,164.00 | $14,391.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,260.97 / $10,154.26 / $16,331.48
| Facility | | $6,260.97 | $10,154.26 | $16,331.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,769.06 / $9,143.09 / $16,267.00
| Facility | | $5,769.06 | $9,143.09 | $16,267.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,283.09 / $8,626.49 / $19,235.75
| Facility | | $4,283.09 | $8,626.49 | $19,235.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $8,438.56 / $17,093.90
| Facility | | $3,308.00 | $8,438.56 | $17,093.90 |