- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,697.80 / $5,927.07 / $12,070.70
| Facility | | $5,697.80 | $5,927.07 | $12,070.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,618.94 / $10,478.65 / $14,060.09
| Facility | | $7,618.94 | $10,478.65 | $14,060.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,242.38 / $8,572.45 / $12,017.17
| Facility | | $6,242.38 | $8,572.45 | $12,017.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,434.56 / $9,520.67 / $12,002.45
| Facility | | $5,434.56 | $9,520.67 | $12,002.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,434.56 / $9,599.92 / $12,588.37
| Facility | | $5,434.56 | $9,599.92 | $12,588.37 |