- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,580.72 / $8,390.76 / $11,880.40
| Facility | | $4,580.72 | $8,390.76 | $11,880.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,251.17 / $8,325.92 / $13,053.41
| Facility | | $5,251.17 | $8,325.92 | $13,053.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,762.56 / $7,547.94 / $13,428.98
| Facility | | $4,762.56 | $7,547.94 | $13,428.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,535.84 / $7,241.34 / $15,879.79
| Facility | | $3,535.84 | $7,241.34 | $15,879.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,030.72 / $7,358.16 / $14,111.61
| Facility | | $3,030.72 | $7,358.16 | $14,111.61 |