- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,796.99 / $10,618.70 / $15,034.90
| Facility | | $5,796.99 | $10,618.70 | $15,034.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,956.45 / $9,548.20 / $15,004.07
| Facility | | $5,956.45 | $9,548.20 | $15,004.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,027.12 / $9,137.48 / $16,994.65
| Facility | | $6,027.12 | $9,137.48 | $16,994.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,474.68 / $9,077.74 / $20,096.21
| Facility | | $4,474.68 | $9,077.74 | $20,096.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $8,816.03 / $17,858.54
| Facility | | $3,308.00 | $8,816.03 | $17,858.54 |