- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,059.99 / $9,268.68 / $13,123.50
| Facility | | $5,059.99 | $9,268.68 | $13,123.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,622.83 / $9,148.86 / $14,762.89
| Facility | | $5,622.83 | $9,148.86 | $14,762.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,260.86 / $8,337.67 / $14,834.03
| Facility | | $5,260.86 | $8,337.67 | $14,834.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,905.79 / $7,896.00 / $17,541.27
| Facility | | $3,905.79 | $7,896.00 | $17,541.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $7,866.58 / $15,588.09
| Facility | | $3,308.00 | $7,866.58 | $15,588.09 |