- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $9,120.11 / $12,589.25
| Facility | | $4,897.79 | $9,120.11 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $7,943.28 / $12,882.50
| Facility | | $5,370.32 | $7,943.28 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $9,772.37 / $13,489.63
| Facility | | $4,786.30 | $9,772.37 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $7,244.36 / $14,791.08
| Facility | | $3,548.13 | $7,244.36 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $7,413.10 / $14,125.38
| Facility | | $3,311.31 | $7,413.10 | $14,125.38 |