- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $9,772.37 / $12,589.25
| Facility | | $6,918.31 | $9,772.37 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $8,511.38 / $12,022.64
| Facility | | $5,888.44 | $8,511.38 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $10,232.93 / $14,454.40
| Facility | | $5,370.32 | $10,232.93 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $9,549.93 / $12,022.64
| Facility | | $6,025.60 | $9,549.93 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $10,232.93 / $14,454.40
| Facility | | $5,495.41 | $10,232.93 | $14,454.40 |