- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,303.20 / $6,275.50 / $10,187.10
| Facility | | $4,303.20 | $6,275.50 | $10,187.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,636.45 / $12,278.02 / $15,741.05
| Facility | | $8,636.45 | $12,278.02 | $15,741.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,052.97 / $9,769.44 / $12,356.57
| Facility | | $5,052.97 | $9,769.44 | $12,356.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,489.67 / $6,748.85 / $10,791.70
| Facility | | $4,489.67 | $6,748.85 | $10,791.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,250.62 / $8,978.62 / $13,641.14
| Facility | | $5,250.62 | $8,978.62 | $13,641.14 |