- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,786.30 / $5,495.41
| Facility | | $3,715.35 | $4,786.30 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $5,623.41 / $6,606.93
| Facility | | $1,202.26 | $5,623.41 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $4,265.80 / $5,128.61
| Facility | | $3,630.78 | $4,265.80 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $5,495.41 / $6,918.31
| Facility | | $3,388.44 | $5,495.41 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $6,456.54 / $7,585.78
| Facility | | $1,445.44 | $6,456.54 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $5,011.87 / $6,606.93
| Facility | | $1,513.56 | $5,011.87 | $6,606.93 |