- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,998.42 / $9,155.89 / $12,963.80
| Facility | | $4,998.42 | $9,155.89 | $12,963.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,247.34 / $10,164.54 / $16,756.62
| Facility | | $6,247.34 | $10,164.54 | $16,756.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,196.84 / $8,236.20 / $14,653.51
| Facility | | $5,196.84 | $8,236.20 | $14,653.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,858.26 / $8,218.75 / $17,327.81
| Facility | | $3,858.26 | $8,218.75 | $17,327.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,307.08 / $7,770.85 / $15,398.39
| Facility | | $3,307.08 | $7,770.85 | $15,398.39 |