- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $6,606.93 / $7,943.28
| Facility | | $5,495.41 | $6,606.93 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $5,888.44 / $9,549.93
| Facility | | $5,754.40 | $5,888.44 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $151.36
| Facility | | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $6,760.83 / $10,471.29
| Facility | | $5,248.07 | $6,760.83 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $8,709.64 / $8,709.64
| Facility | | $4,168.69 | $8,709.64 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $7,585.78 / $11,220.18
| Facility | | $5,495.41 | $7,585.78 | $11,220.18 |