- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,414.02 / $11,748.90 / $16,635.20
| Facility | | $6,414.02 | $11,748.90 | $16,635.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,816.13 / $12,676.48 / $20,388.06
| Facility | | $7,816.13 | $12,676.48 | $20,388.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,668.64 / $10,568.78 / $18,803.54
| Facility | | $6,668.64 | $10,568.78 | $18,803.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,950.96 / $10,252.53 / $22,235.23
| Facility | | $4,950.96 | $10,252.53 | $22,235.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $9,754.40 / $19,759.38
| Facility | | $3,308.00 | $9,754.40 | $19,759.38 |