- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,198.20 / $6,122.38 / $9,938.54
| Facility | | $4,198.20 | $6,122.38 | $9,938.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,688.62 / $13,773.82 / $17,658.74
| Facility | | $9,688.62 | $13,773.82 | $17,658.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,929.67 / $9,531.06 / $12,055.07
| Facility | | $4,929.67 | $9,531.06 | $12,055.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,380.12 / $6,584.18 / $10,528.40
| Facility | | $4,380.12 | $6,584.18 | $10,528.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,764.83 / $8,759.54 / $13,308.29
| Facility | | $5,764.83 | $8,759.54 | $13,308.29 |