- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,895.87 / $7,600.28 / $13,841.56
| Facility | | $4,895.87 | $7,600.28 | $13,841.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,489.78 / $7,958.64 / $13,966.90
| Facility | | $5,489.78 | $7,958.64 | $13,966.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $439.47 / $753.21 / $3,279.67
| Facility | | $439.47 | $753.21 | $3,279.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $752.60 / $1,097.68 / $2,516.35
| Facility | | $752.60 | $1,097.68 | $2,516.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $6,451.00 / $7,934.00
| Facility | | $4,217.00 | $6,451.00 | $7,934.00 |