- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $4,897.79 / $5,370.32
| Facility | | $4,466.84 | $4,897.79 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $5,011.87 / $5,011.87
| Facility | | $5,011.87 | $5,011.87 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $446.68 / $446.68
| Facility | | $234.42 | $446.68 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $5,370.32 / $10,471.29
| Facility | | $3,090.30 | $5,370.32 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $5,011.87 / $8,912.51
| Facility | | $2,344.23 | $5,011.87 | $8,912.51 |