- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,714.80 / $6,875.75 / $11,161.50
| Facility | | $4,714.80 | $6,875.75 | $11,161.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,637.69 / $9,436.45 / $12,098.03
| Facility | | $6,637.69 | $9,436.45 | $12,098.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,536.28 / $10,703.88 / $13,538.48
| Facility | | $5,536.28 | $10,703.88 | $13,538.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,919.10 / $7,394.38 / $11,823.90
| Facility | | $4,919.10 | $7,394.38 | $11,823.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,752.84 / $9,837.43 / $14,945.92
| Facility | | $5,752.84 | $9,837.43 | $14,945.92 |