- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $5,011.87 / $6,760.83
| Facility | | $1,949.84 | $5,011.87 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $4,073.80 / $7,244.36
| Facility | | $3,019.95 | $4,073.80 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,466.84 / $5,011.87
| Facility | | $3,235.94 | $4,466.84 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $5,248.07 / $7,413.10
| Facility | | $4,265.80 | $5,248.07 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,248.07 / $6,918.31
| Facility | | $1,819.70 | $5,248.07 | $6,918.31 |