- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,803.60 / $7,005.25 / $11,371.70
| Facility | | $4,803.60 | $7,005.25 | $11,371.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,724.34 / $13,824.60 / $17,723.84
| Facility | | $9,724.34 | $13,824.60 | $17,723.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,640.56 / $10,905.48 / $13,793.47
| Facility | | $5,640.56 | $10,905.48 | $13,793.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.76 / $7,533.65 / $12,046.60
| Facility | | $5,011.76 | $7,533.65 | $12,046.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,861.19 / $10,022.70 / $15,227.41
| Facility | | $5,861.19 | $10,022.70 | $15,227.41 |