- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $8,317.64 / $11,748.98
| Facility | | $3,467.37 | $8,317.64 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $6,760.83 / $10,715.19
| Facility | | $4,897.79 | $6,760.83 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $10,715.19 / $17,378.01
| Facility | | $7,079.46 | $10,715.19 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $8,128.31 / $17,378.01
| Facility | | $5,888.44 | $8,128.31 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $7,943.28 / $14,791.08
| Facility | | $5,128.61 | $7,943.28 | $14,791.08 |