- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $6,760.83 / $12,589.25
| Facility | | $4,897.79 | $6,760.83 | $12,589.25 |
- 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
- $4,265.80 / $6,760.83 / $8,511.38
| Facility | | $4,265.80 | $6,760.83 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $7,244.36 / $13,489.63
| Facility | | $4,677.35 | $7,244.36 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $6,760.83 / $8,912.51
| Facility | | $4,265.80 | $6,760.83 | $8,912.51 |