- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,106.39 / $5,988.50 / $9,721.21
| Facility | | $4,106.39 | $5,988.50 | $9,721.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,320.45 / $8,667.01 / $9,515.06
| Facility | | $8,320.45 | $8,667.01 | $9,515.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,484.43 / $16,326.84 / $20,931.84
| Facility | | $11,484.43 | $16,326.84 | $20,931.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,821.88 / $9,322.65 / $11,791.47
| Facility | | $4,821.88 | $9,322.65 | $11,791.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,284.34 / $6,440.20 / $10,298.20
| Facility | | $4,284.34 | $6,440.20 | $10,298.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,010.49 / $8,568.00 / $13,017.29
| Facility | | $5,010.49 | $8,568.00 | $13,017.29 |