- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,587.85 / $8,203.62 / $13,208.90
| Facility | | $3,587.85 | $8,203.62 | $13,208.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,374.34 / $5,345.22 / $11,754.34
| Facility | | $1,374.34 | $5,345.22 | $11,754.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,938.36 / $8,923.23 / $13,910.11
| Facility | | $5,938.36 | $8,923.23 | $13,910.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,190.78 / $7,194.11 / $15,108.52
| Facility | | $5,190.78 | $7,194.11 | $15,108.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,873.60 / $7,194.11 / $15,303.60
| Facility | | $4,873.60 | $7,194.11 | $15,303.60 |