- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,329.97 / $7,931.46 / $11,230.10
| Facility | | $4,329.97 | $7,931.46 | $11,230.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,221.41 / $8,410.14 / $13,420.97
| Facility | | $5,221.41 | $8,410.14 | $13,420.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,501.85 / $9,112.86 / $12,693.88
| Facility | | $4,501.85 | $9,112.86 | $12,693.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,342.29 / $6,955.37 / $15,010.54
| Facility | | $3,342.29 | $6,955.37 | $15,010.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,000.00 / $7,117.00 / $13,339.15
| Facility | | $3,000.00 | $7,117.00 | $13,339.15 |