- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $6,918.31 / $9,772.37
| Facility | | $2,951.21 | $6,918.31 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $7,079.46 / $12,022.64
| Facility | | $6,918.31 | $7,079.46 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $9,120.11 / $14,454.40
| Facility | | $5,888.44 | $9,120.11 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $6,918.31 / $14,454.40
| Facility | | $5,011.87 | $6,918.31 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $6,760.83 / $12,589.25
| Facility | | $4,365.16 | $6,760.83 | $12,589.25 |