- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,206.72 / $6,182.40 / $9,545.09
| Facility | | $4,206.72 | $6,182.40 | $9,545.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,170.66 / $13,037.46 / $16,714.68
| Facility | | $9,170.66 | $13,037.46 | $16,714.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,734.52 / $9,153.74 / $11,577.83
| Facility | | $4,734.52 | $9,153.74 | $11,577.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,206.72 / $6,323.52 / $10,111.60
| Facility | | $4,206.72 | $6,323.52 | $10,111.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,919.71 / $8,412.77 / $12,781.44
| Facility | | $4,919.71 | $8,412.77 | $12,781.44 |