- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,457.38 / $9,996.59 / $14,154.10
| Facility | | $5,457.38 | $9,996.59 | $14,154.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,506.12 / $10,525.30 / $16,723.16
| Facility | | $6,506.12 | $10,525.30 | $16,723.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,674.02 / $8,992.45 / $15,999.02
| Facility | | $5,674.02 | $8,992.45 | $15,999.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,212.53 / $8,973.16 / $18,918.87
| Facility | | $4,212.53 | $8,973.16 | $18,918.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $8,299.54 / $16,812.29
| Facility | | $3,308.00 | $8,299.54 | $16,812.29 |