- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,503.83 / $5,804.83 / $11,796.90
| Facility | | $4,503.83 | $5,804.83 | $11,796.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,441.76 / $5,567.84 / $6,365.48
| Facility | | $4,441.76 | $5,567.84 | $6,365.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,595.02 / $6,363.56 / $8,276.09
| Facility | | $3,595.02 | $6,363.56 | $8,276.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,710.08 / $5,710.08 / $5,710.08
| Facility | | $5,710.08 | $5,710.08 | $5,710.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,286.00 / $5,521.37 / $7,859.39
| Facility | | $1,286.00 | $5,521.37 | $7,859.39 |