- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,715.79 / $7,648.08 / $12,697.60
| Facility | | $5,715.79 | $7,648.08 | $12,697.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,067.41 / $7,591.28 / $12,859.79
| Facility | | $5,067.41 | $7,591.28 | $12,859.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,592.41 / $8,157.56 / $11,729.58
| Facility | | $6,592.41 | $8,157.56 | $11,729.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,098.13 / $8,223.12 / $22,659.46
| Facility | | $4,098.13 | $8,223.12 | $22,659.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,098.13 / $8,015.28 / $10,989.53
| Facility | | $4,098.13 | $8,015.28 | $10,989.53 |