- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,055.58 / $7,429.92 / $11,645.60
| Facility | | $5,055.58 | $7,429.92 | $11,645.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,160.60 / $11,643.93 / $14,870.98
| Facility | | $8,160.60 | $11,643.93 | $14,870.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,689.87 / $11,095.45 / $16,117.27
| Facility | | $5,689.87 | $11,095.45 | $16,117.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,055.58 / $7,599.52 / $12,152.00
| Facility | | $5,055.58 | $7,599.52 | $12,152.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,649.21 / $10,110.34 / $15,360.55
| Facility | | $6,649.21 | $10,110.34 | $15,360.55 |