- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,617.54 / $8,458.20 / $11,975.90
| Facility | | $4,617.54 | $8,458.20 | $11,975.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,298.81 / $8,593.81 / $13,821.73
| Facility | | $5,298.81 | $8,593.81 | $13,821.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,800.84 / $7,608.60 / $13,536.91
| Facility | | $4,800.84 | $7,608.60 | $13,536.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,564.26 / $7,296.30 / $16,007.43
| Facility | | $3,564.26 | $7,296.30 | $16,007.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,564.26 / $7,873.00 / $16,007.43
| Facility | | $3,564.26 | $7,873.00 | $16,007.43 |