- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,929.12 / $7,244.08 / $11,354.30
| Facility | | $4,929.12 | $7,244.08 | $11,354.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,707.50 / $9,535.71 / $12,225.28
| Facility | | $6,707.50 | $9,535.71 | $12,225.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,547.56 / $10,817.93 / $15,714.14
| Facility | | $5,547.56 | $10,817.93 | $15,714.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,929.12 / $7,409.43 / $11,848.00
| Facility | | $4,929.12 | $7,409.43 | $11,848.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,764.56 / $9,857.45 / $14,976.35
| Facility | | $5,764.56 | $9,857.45 | $14,976.35 |