- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,962.22 / $9,089.61 / $12,869.90
| Facility | | $4,962.22 | $9,089.61 | $12,869.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,420.16 / $8,770.56 / $14,435.77
| Facility | | $5,420.16 | $8,770.56 | $14,435.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,159.22 / $8,176.58 / $14,547.44
| Facility | | $5,159.22 | $8,176.58 | $14,547.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,830.33 / $7,896.00 / $17,202.37
| Facility | | $3,830.33 | $7,896.00 | $17,202.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,830.33 / $8,291.00 / $17,202.37
| Facility | | $3,830.33 | $8,291.00 | $17,202.37 |