- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $7,079.46 / $19,498.45
| Facility | | $4,570.88 | $7,079.46 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $8,317.64 / $12,882.50
| Facility | | $5,754.40 | $8,317.64 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $9,549.93 / $12,882.50
| Facility | | $6,165.95 | $9,549.93 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,183.83 / $28,183.83 / $28,183.83
| Facility | | $28,183.83 | $28,183.83 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $10,471.29 / $15,488.17
| Facility | | $3,801.89 | $10,471.29 | $15,488.17 |