- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,153.20 / $6,056.75 / $9,832.01
| Facility | | $4,153.20 | $6,056.75 | $9,832.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,638.48 / $15,124.19 / $19,389.99
| Facility | | $10,638.48 | $15,124.19 | $19,389.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,876.83 / $9,428.90 / $11,925.85
| Facility | | $4,876.83 | $9,428.90 | $11,925.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,333.17 / $6,513.60 / $10,415.50
| Facility | | $4,333.17 | $6,513.60 | $10,415.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,703.04 / $9,050.52 / $13,165.64
| Facility | | $5,703.04 | $9,050.52 | $13,165.64 |