- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $8,511.38 / $12,022.64
| Facility | | $3,548.13 | $8,511.38 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $9,772.37 / $10,964.78
| Facility | | $8,511.38 | $9,772.37 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $11,220.18 / $17,782.79
| Facility | | $7,244.36 | $11,220.18 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $8,511.38 / $17,782.79
| Facility | | $6,025.60 | $8,511.38 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $8,128.31 / $15,135.61
| Facility | | $5,248.07 | $8,128.31 | $15,135.61 |