- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,018.92 / $5,906.40 / $9,118.96
| Facility | | $4,018.92 | $5,906.40 | $9,118.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,137.41 / $7,535.36 / $9,554.15
| Facility | | $6,137.41 | $7,535.36 | $9,554.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,892.81 / $11,220.80 / $14,385.64
| Facility | | $7,892.81 | $11,220.80 | $14,385.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,523.14 / $8,745.09 / $11,060.96
| Facility | | $4,523.14 | $8,745.09 | $11,060.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,018.92 / $6,041.22 / $9,660.17
| Facility | | $4,018.92 | $6,041.22 | $9,660.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,700.08 / $8,037.20 / $12,210.84
| Facility | | $4,700.08 | $8,037.20 | $12,210.84 |