- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,097.25 / $11,168.70 / $15,813.70
| Facility | | $6,097.25 | $11,168.70 | $15,813.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,947.43 / $8,329.34 / $12,771.86
| Facility | | $4,947.43 | $8,329.34 | $12,771.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,339.30 / $10,046.83 / $17,874.91
| Facility | | $6,339.30 | $10,046.83 | $17,874.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,706.45 / $9,479.17 / $21,137.11
| Facility | | $4,706.45 | $9,479.17 | $21,137.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $9,272.67 / $18,783.54
| Facility | | $3,308.00 | $9,272.67 | $18,783.54 |