- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $9,120.11 / $13,489.63
| Facility | | $6,918.31 | $9,120.11 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $6,025.60 / $8,128.31
| Facility | | $6,025.60 | $6,025.60 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $7,943.28 / $13,489.63
| Facility | | $5,011.87 | $7,943.28 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $10,715.19 / $15,135.61
| Facility | | $6,760.83 | $10,715.19 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $9,549.93 / $14,791.08
| Facility | | $6,606.93 | $9,549.93 | $14,791.08 |