- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,269.47 / $9,652.40 / $13,666.80
| Facility | | $5,269.47 | $9,652.40 | $13,666.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,410.77 / $8,673.45 / $13,636.77
| Facility | | $5,410.77 | $8,673.45 | $13,636.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,478.66 / $8,682.85 / $15,448.16
| Facility | | $5,478.66 | $8,682.85 | $15,448.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,067.49 / $8,192.26 / $18,267.48
| Facility | | $4,067.49 | $8,192.26 | $18,267.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $8,192.26 / $16,233.44
| Facility | | $3,308.00 | $8,192.26 | $16,233.44 |