- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $6,918.31 / $10,232.93
| Facility | | $5,248.07 | $6,918.31 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $5,623.41 / $12,882.50
| Facility | | $5,623.41 | $5,623.41 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $6,025.60 / $10,232.93
| Facility | | $3,801.89 | $6,025.60 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $7,943.28 / $10,471.29
| Facility | | $5,248.07 | $7,943.28 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $7,762.47 / $11,481.54
| Facility | | $5,370.32 | $7,762.47 | $11,481.54 |