- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $9,120.11 / $12,302.69
| Facility | | $4,897.79 | $9,120.11 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $7,943.28 / $13,182.57
| Facility | | $5,248.07 | $7,943.28 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $9,772.37 / $13,182.57
| Facility | | $4,677.35 | $9,772.37 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $7,244.36 / $14,454.40
| Facility | | $3,467.37 | $7,244.36 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $7,413.10 / $14,125.38
| Facility | | $3,311.31 | $7,413.10 | $14,125.38 |