- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,730.34 / $10,496.60 / $14,862.10
| Facility | | $5,730.34 | $10,496.60 | $14,862.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,825.75 / $11,152.87 / $18,036.90
| Facility | | $6,825.75 | $11,152.87 | $18,036.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,957.82 / $9,442.24 / $16,799.25
| Facility | | $5,957.82 | $9,442.24 | $16,799.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,423.22 / $9,276.82 / $19,865.14
| Facility | | $4,423.22 | $9,276.82 | $19,865.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,423.22 / $9,481.42 / $19,865.14
| Facility | | $4,423.22 | $9,481.42 | $19,865.14 |