- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,621.15 / $10,296.60 / $14,578.90
| Facility | | $5,621.15 | $10,296.60 | $14,578.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,021.15 / $9,632.81 / $15,151.15
| Facility | | $6,021.15 | $9,632.81 | $15,151.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,844.30 / $9,262.33 / $16,479.16
| Facility | | $5,844.30 | $9,262.33 | $16,479.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,338.95 / $8,935.45 / $19,486.63
| Facility | | $4,338.95 | $8,935.45 | $19,486.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $8,548.62 / $17,316.84
| Facility | | $3,308.00 | $8,548.62 | $17,316.84 |