- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $6,456.54 / $7,413.10
| Facility | | $5,011.87 | $6,456.54 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $4,168.69 / $5,888.44
| Facility | | $4,168.69 | $4,168.69 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $5,754.40 / $6,918.31
| Facility | | $4,897.79 | $5,754.40 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $7,413.10 / $9,332.54
| Facility | | $4,570.88 | $7,413.10 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $4,786.30 / $6,760.83
| Facility | | $4,786.30 | $4,786.30 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $6,760.83 / $8,709.64
| Facility | | $1,513.56 | $6,760.83 | $8,709.64 |