- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $5,754.40 / $8,128.31
| Facility | | $2,454.71 | $5,754.40 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $4,265.80 / $4,897.79
| Facility | | $4,265.80 | $4,265.80 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $7,585.78 / $12,022.64
| Facility | | $4,897.79 | $7,585.78 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $5,754.40 / $12,022.64
| Facility | | $4,168.69 | $5,754.40 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $5,623.41 / $10,232.93
| Facility | | $3,630.78 | $5,623.41 | $10,232.93 |