- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,405.96 / $9,902.40 / $14,020.70
| Facility | | $5,405.96 | $9,902.40 | $14,020.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,115.69 / $10,001.79 / $16,284.71
| Facility | | $6,115.69 | $10,001.79 | $16,284.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,620.56 / $8,907.74 / $15,848.28
| Facility | | $5,620.56 | $8,907.74 | $15,848.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,172.84 / $8,404.44 / $18,740.62
| Facility | | $4,172.84 | $8,404.44 | $18,740.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $8,291.00 / $16,653.89
| Facility | | $3,308.00 | $8,291.00 | $16,653.89 |