- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $7,943.28 / $11,748.98
| Facility | | $6,025.60 | $7,943.28 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $6,606.93 / $6,606.93
| Facility | | $6,606.93 | $6,606.93 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $6,918.31 / $11,481.54
| Facility | | $4,365.16 | $6,918.31 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $9,120.11 / $12,022.64
| Facility | | $6,025.60 | $9,120.11 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $8,709.64 / $13,182.57
| Facility | | $6,025.60 | $8,709.64 | $13,182.57 |