- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,906.68 / $8,739.83 / $14,510.20
| Facility | | $5,906.68 | $8,739.83 | $14,510.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,203.03 / $7,965.02 / $13,375.08
| Facility | | $5,203.03 | $7,965.02 | $13,375.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,826.87 / $8,901.68 / $13,403.96
| Facility | | $6,826.87 | $8,901.68 | $13,403.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,683.13 / $9,358.76 / $23,265.91
| Facility | | $4,683.13 | $9,358.76 | $23,265.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,683.13 / $9,159.44 / $12,558.27
| Facility | | $4,683.13 | $9,159.44 | $12,558.27 |