- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,501.82 / $16,219.20 / $26,363.10
| Facility | | $9,501.82 | $16,219.20 | $26,363.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,687.00 / $12,655.93 / $17,007.47
| Facility | | $9,687.00 | $12,655.93 | $17,007.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,147.75 / $12,886.99 / $20,330.48
| Facility | | $8,147.75 | $12,886.99 | $20,330.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,565.53 / $11,736.03 / $22,827.75
| Facility | | $6,565.53 | $11,736.03 | $22,827.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,289.00 / $13,648.07 / $18,535.16
| Facility | | $6,289.00 | $13,648.07 | $18,535.16 |