- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $5,011.87 / $5,011.87
| Facility | | $5,011.87 | $5,011.87 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $7,585.78 / $12,022.64
| Facility | | $4,786.30 | $7,585.78 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,135.61 / $19,952.62 / $20,892.96
| Facility | | $15,135.61 | $19,952.62 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $5,011.87 / $11,481.54
| Facility | | $5,011.87 | $5,011.87 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $7,943.28 / $11,748.98
| Facility | | $5,370.32 | $7,943.28 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $7,413.10 / $7,943.28
| Facility | | $5,754.40 | $7,413.10 | $7,943.28 |