- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,769.00 / $8,858.68 / $12,173.80
| Facility | | $5,769.00 | $8,858.68 | $12,173.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,867.92 / $7,775.78 / $8,781.96
| Facility | | $6,867.92 | $7,775.78 | $8,781.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,168.07 / $8,025.82 / $12,159.29
| Facility | | $5,168.07 | $8,025.82 | $12,159.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,254.88 / $7,666.83 / $12,270.16
| Facility | | $5,254.88 | $7,666.83 | $12,270.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,281.48 / $7,666.83 / $11,185.82
| Facility | | $5,281.48 | $7,666.83 | $11,185.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,213.52 / $9,939.29 / $13,531.61
| Facility | | $5,213.52 | $9,939.29 | $13,531.61 |